Requirements for the calculation of an enrollee's contribution toward cost-sharing and out-of-pocket maximum set.

Summary

The bill tells health insurers and pharmacy benefit managers to include any money an enrollee pays—or that someone else pays for them—when figuring the enrollee’s contribution toward cost‑sharing and out‑of‑pocket maximums. It applies to prescription drugs whether they fall under medical or pharmacy benefits, and it only counts payments after the deductible is met if earlier counting would make a health‑savings account or catastrophic plan ineligible. The rule takes effect on Jan. 1, 2027 for plans issued or renewed after that date.

AI-generated summary — may be incomplete or inaccurate. Verify against the official bill text.

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