SB23-195 Summary

• Requires health insurers and pharmacy benefit managers (PBMs) to count cost-sharing assistance payments toward patients' deductibles and annual out-of-pocket limits under health benefit plans.

• Applies to prescription drugs without generic equivalents or biosimilars, and to brand-name drugs approved through prior authorization, step-therapy compliance, or insurer exceptions processes.

• Prohibits "accumulator adjustment programs" that exclude cost-sharing assistance from deductible and out-of-pocket maximum calculations, preventing insurers from requiring patients to pay deductibles twice.

• Includes exception for health savings accounts (HSAs) to maintain federal tax eligibility under Internal Revenue Code Section 223, allowing application only after minimum deductible requirements are met.

• Effective for health benefit plans issued or renewed on or after January 1, 2025, subject to voter approval if a referendum petition is filed within 90 days of final adjournment.