NE LB158

Health carriers and pharmacy benefit managers must count payments made by enrollees or on their behalf by third parties (such as manufacturer copay assistance programs) toward out-of-pocket maximums and cost-sharing requirements under health benefit plans

Applies to health benefit plans entered into, amended, extended, or renewed on or after January 1, 2026

Cost-sharing requirements covered include copayments, deductibles, and annual cost-sharing limits for health care services and prescription drugs under both medical and pharmacy benefits

For health savings account (HSA)-eligible plans, the requirement only applies after the enrollee meets the minimum deductible under IRS Section 223, except for preventive care services which count immediately