Require Health Insurance Carriers and Pharmacy Benefits Managers To Appropriately Account for Cost-sharing Amounts Paid on Behalf of Insureds
| Category: | Pharmacy Related |
|---|---|
| Status: | Passed |
| Sponsor: | Senator Heather Sanborn, Senate 28 - Cumberland County |
| Session: | 130 |
| Bill #: | LD 1783 |
Position:
Monitoring.
UPDATE 5/8/22: This bill becomes law without Governor Mills' signature.
Summary:
This bill requires health insurance carriers and their pharmacy benefits managers to include cost-sharing amounts paid on behalf of an insured when calculating the insured's contribution to any out-of-pocket maximum, deductible or copayment when a drug does not have an alternative equivalent or was obtained through prior authorization, a step therapy override exception or an exception or appeal process. The bill’s requirements apply to prescription drug benefits provided pursuant to a contract or policy of insurance by a carrier or a pharmacy benefits manager on behalf of a carrier on or after January 1, 2023.