SENATE DOCKET, NO. 1341        FILED ON: 1/19/2017

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 516

 

The Commonwealth of Massachusetts

_________________

PRESENTED BY:

Sal N. DiDomenico

_________________

To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:

The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:

An Act relative to out-of-pocket expenses for prescription drug coverage.

_______________

PETITION OF:

 

Name:

District/Address:

 

Sal N. DiDomenico

Middlesex and Suffolk

 

Jack Lewis

7th Middlesex

1/23/2017

Linda Dorcena Forry

First Suffolk

1/27/2017

Patricia D. Jehlen

Second Middlesex

1/27/2017

David Paul Linsky

5th Middlesex

1/27/2017

William N. Brownsberger

Second Suffolk and Middlesex

1/27/2017

Marjorie C. Decker

25th Middlesex

1/29/2017

Brian M. Ashe

2nd Hampden

1/30/2017

Joseph W. McGonagle, Jr.

28th Middlesex

1/30/2017

Antonio F. D. Cabral

13th Bristol

2/1/2017

Edward F. Coppinger

10th Suffolk

2/2/2017

Barbara A. L'Italien

Second Essex and Middlesex

2/2/2017

Kay Khan

11th Middlesex

2/2/2017

Solomon Goldstein-Rose

3rd Hampshire

2/2/2017

John J. Mahoney

13th Worcester

2/2/2017

Elizabeth A. Malia

11th Suffolk

2/3/2017

Michael O. Moore

Second Worcester

2/3/2017

Natalie Higgins

4th Worcester

2/3/2017

Sean Garballey

23rd Middlesex

2/3/2017

William C. Galvin

6th Norfolk

2/3/2017

Julian Cyr

Cape and Islands

2/3/2017

Carolyn C. Dykema

8th Middlesex

2/14/2017


SENATE DOCKET, NO. 1341        FILED ON: 1/19/2017

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 516

By Mr. DiDomenico, a petition (accompanied by bill, Senate, No. 516) of Sal N. DiDomenico, Jack Lewis, Linda Dorcena Forry, Patricia D. Jehlen and other members of the General Court for legislation relative to out-of-pocket expenses for prescription drug coverage.  Financial Services.

 

[SIMILAR MATTER FILED IN PREVIOUS SESSION
SEE SENATE, NO. 541 OF 2015-2016.]

 

The Commonwealth of Massachusetts

 

_______________

In the One Hundred and Ninetieth General Court
(2017-2018)

_______________

 

An Act relative to out-of-pocket expenses for prescription drug coverage.

 

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
 

SECTION 1.  Chapter 175 of the General Laws is hereby amended by inserting after section 277 the following section:

Section 228. Patient Cost-Sharing Obligation for Prescription Drugs

(A) As used in this section the following words shall, unless the context clearly requires otherwise, have the following meanings:-

“Connector” means the Commonwealth health insurance connector authority.

(B) Not withstanding any law, after January 1, 2018, each health insurance carrier shall apply the prescription drug cost-sharing provisions of the Connector standard benefit design to all state regulated plans, including non-standard plans sold through the Connector and state regulated plans sold outside of the Connector.  Cost-sharing includes copayments, coinsurance, and deductibles.

(C) A health plan that meets the requirements of a catastrophic plan, as defined in 45 C.F.R. § 156.155, shall be exempt from the requirements of subsection B.

(D) For any enrollee that is enrolled in a plan that, but for the requirements of subsections B would be a High Deductible Health Plan as defined in section 223(c)(2) of the Internal Revenue Code of 1986, subsection B shall be applicable only after the minimum annual deductible specified in section 223(c)(2) of the Internal Revenue Code of 1986 is reached.

(E) The Massachusetts Division of Insurance shall promulgate any regulations necessary to implement and enforce this Act.

SECTION 2.  Chapter 176A of the General Laws is hereby amended by inserting after section 38 the following section:

Section 39. Patient Cost-Sharing Obligation for Prescription Drugs

(A) As used in this section the following words shall, unless the context clearly requires otherwise, have the following meanings:-

“Connector” means the Commonwealth health insurance connector authority.

(B) Not withstanding any law, after January 1, 2018, each health insurance carrier shall apply the prescription drug cost-sharing provisions of the Connector standard benefit design to all state regulated plans, including non-standard plans sold through the Connector and state regulated plans sold outside of the Connector.  Cost-sharing includes copayments, coinsurance, and deductibles.

(C) A health plan that meets the requirements of a catastrophic plan, as defined in 45 C.F.R. § 156.155, shall be exempt from the requirements of subsection B.

(D) For any enrollee that is enrolled in a plan that, but for the requirements of subsections B would be a High Deductible Health Plan as defined in section 223(c)(2) of the Internal Revenue Code of 1986, subsection B shall be applicable only after the minimum annual deductible specified in section 223(c)(2) of the Internal Revenue Code of 1986 is reached.

(E) The Massachusetts Division of Insurance shall promulgate any regulations necessary to implement and enforce this Act.

SECTION 3.   Chapter 176B of the General Laws is hereby amended by inserting after section 24 the following section:

Section 25. Patient Cost-Sharing Obligation for Prescription Drugs

(A) As used in this section the following words shall, unless the context clearly requires otherwise, have the following meanings:-

“Connector” means the Commonwealth health insurance connector authority.

(B) Not withstanding any law, after January 1, 2018, each health insurance carrier shall apply the prescription drug cost-sharing provisions of the Connector standard benefit design to all state regulated plans, including non-standard plans sold through the Connector and state regulated plans sold outside of the Connector.  Cost-sharing includes copayments, coinsurance, and deductibles.

(C) A health plan that meets the requirements of a catastrophic plan, as defined in 45 C.F.R. § 156.155, shall be exempt from the requirements of subsection B.

(D) For any enrollee that is enrolled in a plan that, but for the requirements of subsections B would be a High Deductible Health Plan as defined in section 223(c)(2) of the Internal Revenue Code of 1986, subsection B shall be applicable only after the minimum annual deductible specified in section 223(c)(2) of the Internal Revenue Code of 1986 is reached.

(E) The Massachusetts Division of Insurance shall promulgate any regulations necessary to implement and enforce this Act.

SECTION 4.   Chapter 176G of the General Laws is hereby amended by inserting after section 32 the following section:

Section 33. Patient Cost-Sharing Obligation for Prescription Drugs

(A) As used in this section the following words shall, unless the context clearly requires otherwise, have the following meanings:-

“Connector” means the Commonwealth health insurance connector authority.

(B) Not withstanding any law, after January 1, 2018, each health insurance carrier shall apply the prescription drug cost-sharing provisions of the Connector standard benefit design to all state regulated plans, including non-standard plans sold through the Connector and state regulated plans sold outside of the Connector.  Cost-sharing includes copayments, coinsurance, and deductibles.

(C) A health plan that meets the requirements of a catastrophic plan, as defined in 45 C.F.R. § 156.155, shall be exempt from the requirements of subsection B.

(D) For any enrollee that is enrolled in a plan that, but for the requirements of subsections B would be a High Deductible Health Plan as defined in section 223(c)(2) of the Internal Revenue Code of 1986, subsection B shall be applicable only after the minimum annual deductible specified in section 223(c)(2) of the Internal Revenue Code of 1986 is reached.

(E) The Massachusetts Division of Insurance shall promulgate any regulations necessary to implement and enforce this Act.

SECTION 5.  Chapter 32A of the General Laws is hereby amended by inserting after section 27 the following section:

Section 28. Patient Cost-Sharing Obligation for Prescription Drugs

(A) As used in this section the following words shall, unless the context clearly requires otherwise, have the following meanings:-

“Connector” means the Commonwealth health insurance connector authority.

(B) Not withstanding any law, after January 1, 2018, each health insurance carrier shall apply the prescription drug cost-sharing provisions of the Connector standard benefit design to all state regulated plans, including non-standard plans sold through the Connector and state regulated plans sold outside of the Connector.  Cost-sharing includes copayments, coinsurance, and deductibles.

(C) A health plan that meets the requirements of a catastrophic plan, as defined in 45 C.F.R. § 156.155, shall be exempt from the requirements of subsection B.

(D) For any enrollee that is enrolled in a plan that, but for the requirements of subsections B would be a High Deductible Health Plan as defined in section 223(c)(2) of the Internal Revenue Code of 1986, subsection B shall be applicable only after the minimum annual deductible specified in section 223(c)(2) of the Internal Revenue Code of 1986 is reached.

(E) The Massachusetts Division of Insurance shall promulgate any regulations necessary to implement and enforce this Act.

SECTION 6. This Act shall take effect January 1, 2018.