Bill > HB413

This bill establishes comprehensive regulations for prescription drug cost-sharing and rebates in Kentucky's health insurance system. It requires insurers and pharmacy benefit managers to calculate an insured's cost-sharing for prescription drugs at the point of sale, with rebates being passed through to reduce the consumer's out-of-pocket expenses by at least 85%. The bill mandates that any remaining rebates must be used to lower health plan premiums. To protect sensitive financial information, the actual rebate amounts are classified as trade secrets and cannot be publicly disclosed in a way that could identify specific products, manufacturers, or pharmacies. The legislation applies to various types of health plans, including state employee health plans, limited health service organizations, and self-insured employer group health plans at state postsecondary institutions. Importantly, the bill prohibits insurers from requiring patients to pay more for a prescription drug with insurance than they would without insurance and ensures that all cost-sharing amounts are counted towards deductibles and out-of-pocket maximums. The new regulations will take effect for health plans issued or renewed on or after January 1, 2026, giving insurers and healthcare organizations time to adapt to the new requirements.

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https://apps.legislature.ky.gov/record/25RS/hb413.html