SB 354 (2024)

When calculating an enrollee's contribution to cost-sharing requirements, this bill requires the insurer or pharmacy benefits manager to include any amount paid by the enrollee or paid on their behalf. The bill includes a limited exception for health savings account-qualified high deductible health plans. According to the Insurance Department, this bill may result in decreased enrollee cost-sharing contributions and increased costs to insurance carriers and pharmacy benefit managers for system updates. The Senate also added this bill text to HB 1380, although the House rejected that addition.

The House rewrote the bill. The House version of the bill requires an insurer to apply any amount paid by an independent charity patient assistance program to the enrollee's cost sharing requirements, except in the case of a covered prescription drug for which there is a generic, biosimilar, or other covered alternative. According to the House Commerce and Consumer Affairs Committee, this amended bill "will ensure that a patient who has health insurance under their employer's fully insured plan and receives means-tested financial assistance from an independent charity patient assistance program can count the financial assistance toward their deductible or out-of-pocket maximum."

The House and Senate could not agree on a final version of the bill.