This bill requires health insurance plans and insurers to base patient cost-sharing for prescription drugs on the actual net price paid by the insurance company rather than the inflated list price. Specifically, when patients have a deductible or coinsurance obligation, their out-of-pocket costs must be calculated using the negotiated net price after all rebates and discounts are applied, preventing patients from paying a percentage of the higher list price. The legislation does not affect fixed copayments and contains a narrow exception for drugs where the net and list prices differ by one cent or less. The reform takes effect on January 1, 2025, and applies to both group health plans and individual insurance coverage. By tying patient costs to actual negotiated prices rather than list prices, the bill aims to pass pharmaceutical rebates directly to consumers at the point of sale rather than allowing those savings to be retained by insurers or pharmacy benefit managers.
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