Am. H.B. No. 135 Summary

• Requires copayments, cost sharing, and deductibles to be reasonable and not a barrier to necessary utilization of health care services, with annual cost-sharing limits not exceeding 40% of total annual cost to provide covered services.

• Mandates that when calculating enrollee/insured contribution to prescription drug cost-sharing, all amounts paid by the enrollee and on behalf of the enrollee by another person, group, or organization must be included.

• Exempts brand prescription drugs from the inclusion requirement if a medically appropriate generic equivalent exists, unless the prescriber determines the brand drug is medically necessary.

• Prohibits lifetime maximums on basic health care services, though health insurers may establish benefit limits for inpatient hospital services under supplemental health care agreements.

• Applies to health benefit plans delivered, issued for delivery, modified, or renewed on or after January 1, 2022, and extends cost-sharing requirements to pharmacy benefit managers.