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SB 423

Requiring certain cost-sharing assistance be applied toward a covered individual's deductible or annual out-of-pocket limit under the individual's health benefit plan.

2025-2026 Regular Session Introduced by Dinah Sykes

Bill requires health insurers to count third-party cost-sharing assistance toward patients' deductibles and out-of-pocket maximums.

Died in Committee
#insurance
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WeVote Research Nonpartisan
Bill Summary · SB 423

Legislative bill overview

SB 423 mandates that cost-sharing assistance programs (such as patient assistance programs, charity care, or copay coupons) must be counted toward a patient's deductible and annual out-of-pocket maximums in their health insurance plans. Currently, many of these assistance programs don't count toward these limits, allowing patients to reduce their costs without meeting their plan's financial thresholds. This bill would integrate third-party assistance into the calculation of how much patients have satisfied their plan's cost-sharing obligations.

Why is this important

This directly affects healthcare affordability for individuals using assistance programs—it could either help patients reach their deductibles faster (reducing subsequent out-of-pocket costs) or complicate the assistance landscape depending on implementation. For insurers and pharmaceutical companies offering assistance, it changes the financial calculus of their programs. The policy sits at the intersection of consumer protection, insurance regulation, and healthcare industry practices.

Potential points of contention

  • Insurer financial impact: Counting assistance toward deductibles/out-of-pocket limits may increase insurer payouts, potentially leading to higher premiums
  • Assistance program viability: Pharmaceutical and nonprofit programs may reduce or eliminate assistance if it counts toward plan limits, ultimately hurting patients
  • Implementation complexity: Determining which assistance programs qualify and how they integrate with plan accounting systems poses operational challenges

Compiled from official sources — confirm details with the bill’s official record.

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