Bill > S3818

This bill requires health insurance carriers and pharmacy benefits managers to apply third-party discounts and payments directly to an individual's cost-sharing amounts, such as copayments, coinsurance, and deductibles. The bill defines key terms like "carrier" (which includes various types of health insurance providers), "enrollee" (an individual covered by a health benefits plan), and "cost-sharing amount" (out-of-pocket expenses for healthcare services). It mandates that when calculating an enrollee's cost-sharing requirement, carriers must credit any amount paid by a third party. The bill also prohibits carriers and pharmacy benefits managers from altering health plan coverage terms based on the availability of financial assistance for prescription drugs. Carriers and pharmacy benefits managers must annually certify their compliance with these requirements to the Commissioner of Banking and Insurance, and the bill applies to most health benefits plans, excluding specific types like worker's compensation, Medicare supplements, and self-insured plans. The legislation aims to provide more transparency and fairness in healthcare cost-sharing by ensuring that financial assistance directly reduces an individual's out-of-pocket expenses. The bill will take effect 90 days after enactment and will apply to health plans delivered or renewed after that date.