KY HB365

Health benefit plans providing prescription drug coverage must cover therapeutic food, formulas, supplements, and low-protein modified food for treatment of inborn errors of metabolism or genetic conditions, with annual caps of $25,000 for therapeutic products and $4,000 for low-protein modified foods, subject to CPI-U inflation adjustments

New requirement for health benefit plans to cover physician-prescribed enteral infant and baby formulas that are medically necessary and proven effective as disease-specific treatment, with a $3,000 annual cap subject to inflation adjustments

Coverage requirements apply to Medicaid, managed care organizations, KCHIP (Kentucky Children's Health Insurance Program), state employee health plans, and self-insured employer plans offered by state postsecondary institutions

Exemptions provided for Health Savings Account-qualified High Deductible Health Plans until minimum deductible requirements are met, and for qualified health plans if federal cost defrayal requirements would be triggered

Effective date of January 1, 2027 for health benefit plan requirements; Medicaid-related provisions require federal approval within 90 days if state plan amendment or waiver is necessary