Bill > H828

This bill mandates that all health insurance policies, contracts, and plans in the Commonwealth that cover prescription drugs, including expensive specialty drugs, must establish a separate limit on how much patients have to pay out-of-pocket for these medications. This separate out-of-pocket limit cannot exceed the minimum annual deductible amount set for a "high deductible health plan" (a type of health insurance plan with a higher deductible than typical plans, often paired with a health savings account) under federal law, for both individual and family coverage. The term "out-of-pocket limit" in this context refers to patient expenses that are considered cost-sharing (like copayments or coinsurance) and specifically relate to prescription drug coverage, as defined by the federal Patient Protection and Affordable Care Act. This new requirement will apply to insurance policies issued, delivered, or renewed on or after January 1, 2015.