summary
Introduced
01/16/2026
01/16/2026
In Committee
01/16/2026
01/16/2026
Crossed Over
Passed
Dead
Introduced Session
2026 Regular Session
Bill Summary
Amend KRS 304.17A-164 to define terms; prohibit insurers and administrators from requiring insureds to pay cost sharing for a prescription drug that is greater than the cash price; require insurers and administrators to count the amount paid for a covered prescription drug towards the insured's cost-sharing if certain requirements are met; establish requirements for insurers, administrators, and pharmacies for submission of cash price paid by an insured; exempt a state employee health plan from counting third-party payments unless a cash price was paid that is less than the plan's negotiated price; provide for construction of cost-sharing requirements; amend KRS 304.17C-125, 304.38A-115, 164.2871, and 18A.225 to apply cost-sharing requirements to limited health plans, self-insured state postsecondary education institution employer group health plans, and the state employee health plan; create a new section of KRS Chapter 315 to require pharmacies to comply with cost-sharing requirements; provide that cost-sharing requirements apply to health plans issued or renewed on or after effective date; EFFECTIVE, January 1, 2027.
AI Summary
This bill aims to ensure that individuals do not pay more for prescription drugs than the drug's cash price, meaning the price someone would pay without insurance. It prohibits insurers and administrators from requiring patients to pay cost-sharing, which includes copayments, coinsurance, or deductibles, that exceeds the cash price of a covered prescription drug. The bill also mandates that any amount paid by an insured person towards the cost of a prescription drug, including the cash price if it's less than the plan's negotiated price, must count towards their overall cost-sharing limits. Additionally, it requires insurers and administrators to establish clear procedures for submitting proof of cash payments and ensures pharmacies comply with these new cost-sharing requirements. These provisions will apply to health plans issued or renewed on or after January 1, 2027, and are extended to various types of health plans, including limited health plans, self-insured plans for state postsecondary education institutions, and the state employee health plan.
Sponsors (2)
Last Action
to Committee on Committees (S) (on 01/16/2026)
Official Document
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://apps.legislature.ky.gov/record/26RS/sb103.html |
| BillText | https://apps.legislature.ky.gov/recorddocuments/bill/26RS/sb103/orig_bill.pdf |
| Local Mandate Fiscal Impact | https://apps.legislature.ky.gov/recorddocuments/note/26RS/sb103/LM.pdf |
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