Bill > H4492

This bill requires health insurance providers in Massachusetts to establish a separate out-of-pocket limit specifically for prescription drugs, including specialty drugs, across different types of health insurance plans (such as insurance policies, hospital service plans, medical service agreements, and health maintenance organizations). The out-of-pocket limit for prescription drugs cannot exceed the minimum annual deductible for a high deductible health plan as defined by the Internal Revenue Code, with different limits for individual and family coverage. The out-of-pocket limit includes cost-sharing expenses as defined in the federal Patient Protection and Affordable Care Act that are directly related to prescription drug coverage. This provision aims to provide patients with greater financial protection by capping their annual expenses for prescription medications. The bill will apply to all health insurance policies, contracts, and certificates delivered, issued, or renewed on or after January 1, 2026, giving insurance providers time to adjust their plans to comply with the new requirements.

Health and Social Services

Joint Committee on Financial Services (Joint)

https://malegislature.gov/Bills/194/H4492