MA H4492

Requires all health insurance policies providing prescription drug coverage to establish a separate out-of-pocket limit specifically for prescription drugs, including specialty drugs

Caps the prescription drug out-of-pocket limit at the federal minimum annual deductible for high deductible health plans under IRS Code Section 223 (currently $1,650 for self-only coverage and $3,300 for family coverage in 2025)

Applies to multiple insurance types: commercial insurers (Chapter 175), hospital service corporations (Chapter 176A), medical service corporations (Chapter 176B), and health maintenance organizations (Chapter 176G)

Defines "out-of-pocket limit" using the federal Affordable Care Act's cost-sharing expenditure definition under 42 U.S.C. §18022(c)(3)

Takes effect for policies delivered, issued, or renewed on or after January 1, 2026