Creates provisions relating to cost-sharing under health benefit plans

Summary

The bill defines cost‑sharing and forces health insurers and pharmacy‑benefit managers to include any payments for drugs that have no generic substitute when calculating an enrollee’s out‑of‑pocket maximum. It also stops insurers from lowering those limits based on the presence of cost‑sharing assistance programs for such drugs. The rule applies to plans entered into or renewed on or after August 28 2026, except for plans covered by the Labor Management Relations Act.

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