FL H0363

Health insurers, health maintenance organizations, and their pharmacy benefit managers must count any payment made by or on behalf of an insured person — including manufacturer copay cards, product vouchers, and financial assistance — toward the insured's deductible, copayment, coinsurance, and other cost-sharing requirements for prescription drugs that have no generic equivalent or have been authorized through prior authorization, step therapy, or an exception/appeal process.

"Cost-sharing requirement" is defined broadly to include dollar limits, deductibles, copayments, coinsurance, and any other out-of-pocket expense, including the annual out-of-pocket maximum under federal law (42 U.S.C. § 18022).

Contracts between health insurers/HMOs and pharmacy benefit managers must require PBMs to apply third-party payments toward insureds' cost-sharing obligations and to disclose this requirement to every insured.

Health insurers and HMOs must disclose on their websites and in every policy, contract, certificate, or member handbook that third-party payments will be applied toward cost-sharing requirements.

Applies to individual, group, small employer health insurance policies and HMO contracts issued, delivered, or renewed on or after January 1, 2025, with an overall effective date of July 1, 2024.