Application of prescription drug payments to health insurance cost-sharing requirements. Health insurance policies and plans often apply deductibles and out-of-pocket
maximum amounts to the benefits covered by the policy or plan. A deductible is an
amount that an enrollee in a policy or plan must pay out of pocket before attaining
the full benefits of the policy or plan. An out-of-pocket maximum amount is a limit
specified by a policy or plan on the amount that an enrollee pays, and, once that limit
is reached, the policy or plan covers the benefit entirely. This bill generally requires
health insurance policies that offer prescription drug benefits, self-insured health
plans, and pharmacy benefit managers acting on behalf of policies or plans to apply
amounts paid by or on behalf of an individual covered under the policy or plan for
brand name prescription drugs to any cost-sharing requirement or to any
calculation of an out-of-pocket maximum amount of the policy or plan. Health
insurance policies are referred to in the bill as disability insurance policies.