Bill
HF 735
Summary of HF 735: A Bill Relating to Health Carriers, Pharmacy Benefits Managers, and Cost-Sharing Contributions OverviewHF 735 is a bill introduced in the state legislature that
HF 735 is a bill introduced in the state legislature that aims to regulate the practices of health insurance carriers and pharmacy benefits managers (PBMs) when it comes to calculating cost-sharing contributions for covered individuals.
Calculation of Cost-Sharing Contributions: The bill requires health insurance carriers and PBMs to base a covered person's cost-sharing contribution (such as deductibles, copayments, and coinsurance) on the lowest available price of a prescription drug, rather than the list price or wholesale acquisition cost. This includes accounting for any rebates, discounts, or other price concessions negotiated by the PBM.
Transparency Requirements: Health carriers and PBMs would be required to provide covered persons with information about the actual cost of their prescription drugs and the lowest available price after accounting for concessions. This information must be provided at the time a prescription is filled.
Enforcement: The state insurance commissioner would be granted authority to enforce these requirements and impose civil penalties of up to $1,000 per violation on health carriers or PBMs that fail to comply.
This bill is intended to:
Protect Consumers: By ensuring that an individual's cost-sharing contributions are based on the lowest available price, rather than potentially inflated list prices, it aims to reduce out-of-pocket costs for patients filling prescriptions.
Increase Transparency: The information disclosure requirements are meant to provide consumers with more clarity about the true cost of their medications and how that cost is calculated.
Regulate PBM Practices: The bill targets perceived unfair or deceptive practices by PBMs in how they determine patient cost-sharing amounts.
The changes proposed in HF 735 would apply to all health insurance plans regulated by the state, potentially impacting millions of covered individuals.
Compiled from official sources — confirm details with the bill’s official record.
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