Bill > HB0052

This bill introduces new regulations for health insurance plans and drug discount coupons in Utah, focusing on how cost-sharing requirements are calculated and applied. The bill defines key terms like "biosimilar" (a biological product highly similar to another) and "cost sharing requirement" (copayments, coinsurance, deductibles, or annual cost limitations). It mandates that when calculating an enrollee's out-of-pocket expenses, insurers must include any cost-sharing amounts paid by the enrollee or through drug discount coupons. However, insurers can refuse to apply a drug discount coupon if the drug has a generic alternative or a biosimilar approved for the enrollee's condition. The bill also requires pharmaceutical manufacturers providing drug discount coupons to disclose coupon terms to insurers at least 12 months in advance and prohibits modifying coupon terms based on the health plan's compliance. These provisions will apply to health benefit plans entered into, amended, extended, or renewed on or after July 1, 2026, with the goal of potentially reducing prescription drug costs for enrollees. The bill takes effect on May 7, 2025, and will be enforced by the insurance department within existing budget allocations.

https://le.utah.gov/~2025/bills/static/HB0052.html