HB 05386 Summary

• Individual and group health insurance policies providing outpatient prescription drug coverage must include coverage for at least one epinephrine cartridge injector, effective January 1, 2023.

• Out-of-pocket expenses (copayment, coinsurance, deductible) for epinephrine cartridge injectors cannot exceed $25, with exceptions for high deductible health plans linked to medical savings accounts or health savings accounts to the extent permitted by federal law.

• Defines key terms including "health carrier," "pharmacy benefits manager," "rebate," and "specialty drug" for regulatory purposes.

• Requires pharmacy benefits managers utilizing tiered prescription drug formularies to place at least one covered epinephrine cartridge injector in the lowest cost-sharing tier available.