Amendment ID: S2202-140

Amendment 140

Out of Pocket Payment Caps for Pharmaceutical Drugs

Ms. L'Italien moves to amend the bill by adding at the end thereof the following sections:

"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 these sections.

SECTION 6. These sections shall take effect January 1, 2018."