SC H3934

Requires insurers, third-party administrators, and pharmacy benefit managers to count payments made by or on behalf of an enrollee (including from third parties) toward the enrollee's annual cost-sharing limits under federal law (42 U.S.C. Section 18022(c)(1))

Provides an exception for Health Savings Account-qualified High Deductible Health Plans, where third-party payments count toward cost-sharing only after the enrollee meets the minimum deductible required under IRS Section 223

Excludes prescription drugs that have a medically appropriate generic equivalent, unless the enrollee obtained access to the brand name drug through prior authorization, step therapy, or the insurer's appeals process

Prohibits insurers, third-party administrators, and pharmacy benefit managers from altering health plan benefit design based on information about the availability of financial or product assistance for prescription drugs

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