DE SB265

Requires carriers and pharmacy benefits managers to count third-party cost-sharing assistance (payments made on behalf of patients) toward patients' deductibles and out-of-pocket limits when calculating cost-sharing obligations.

Limits copayment and coinsurance requirements for prescription drugs to the lesser of: the standard copayment/coinsurance, the usual and customary price, or the contract price paid to the pharmacy.

Applies to health benefit plans entered into, amended, extended, or renewed on or after January 1, 2024, covering both commercial insurance carriers and pharmacy benefits managers.

Includes exceptions for Health Savings Account-qualified High Deductible Health Plans to comply with federal tax law, allowing the requirement to apply after minimum deductibles are met, except for preventive care services.

Authorizes the Insurance Commissioner and State Employee Benefit Committee to promulgate rules and regulations necessary to implement and enforce the requirements.