ID H0353

Insurers must count payments made by third parties (including manufacturer coupons) toward an enrollee's deductible and out-of-pocket maximums for covered prescription drugs, effective January 1, 2027

Drug manufacturers providing financial assistance must deliver the full value to enrollees until cost-sharing requirements are met, cannot discontinue coupons mid-year, and must notify enrollees by October 1 if assistance will end the following year

Manufacturers must offer uninsured individuals assistance on terms no less favorable than insured individuals and cannot provide assistance as post-claim reimbursements

Annual reporting required by August 1, 2027 (and each year thereafter) to the Department of Insurance on patient counts, total assistance value, eligibility terms, and state sales for each drug with assistance programs

Provisions do not apply when a medically appropriate generic equivalent or biosimilar is available and deemed appropriate by the patient's doctor