Bill Summary: HB 05366

• Caps aggregate monthly out-of-pocket costs (coinsurance, copayments, deductibles) for covered prescription drugs at $250 per insured per month, effective January 1, 2021.

• Limits wholesale cost of outpatient prescription drugs to 102% of the consumer price index for the preceding year, effective January 1, 2021.

• Establishes a Canadian legend drug importation program to be administered by the Commissioner of Consumer Protection, requiring federal approval and implementation by July 1, 2021 if approved.

• Requires pharmaceutical manufacturers to notify the Insurance Commissioner within 30 days of entering "pay-for-delay" agreements delaying generic drug entry; mandates health carriers and pharmacy benefit managers reduce costs of affected brand name drugs by 50% of wholesale list price.

• Restricts health carriers from removing drugs from formularies or moving drugs to higher cost-sharing tiers during plan years except for FDA safety concerns or when generic alternatives become available at lower costs.