ARIZONA
HOUSE OF REPRESENTATIVES
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HB 2166: |
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NOW: health plans; cost sharing; calculation |
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PRIME SPONSOR: Representative Barto, LD 15 BILL STATUS: Senate Engrossed Senate 3rd Read: 29-0-1-0 |
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Requires a health care insurer to include
any cost sharing amount paid by either the enrollee or another person on behalf
of the enrollee when calculating an enrollee's contribution to any out-of-pocket
maximum, deductible, copayment, coinsurance or other applicable cost sharing
requirements.
History
A.R.S. § 20-3111 defines cost sharing requirements as an enrollees' applicable coinsurance, copayment and deductible requirements under a health plan.
Provisions
1. Requires a health care insurer that provides pharmacy benefits, or a pharmacy benefits manager that administers pharmacy benefits for a health care insurer, to include any cost sharing amount paid by either the enrollee or another person on behalf of the enrollee when calculating an enrollee's contribution to any out-of-pocket maximum, deductible, copayment, coinsurance or other applicable cost sharing requirements.
2. Defines health care insurer.
Senate Amendments
1. Provides that a health care insurer that provides pharmacy benefits, or a pharmacy benefits manager that administers pharmacy benefits for a health care insurer, to include any cost sharing amount paid by either the enrollee or another person on behalf of the enrollee for a prescription drug that is either:
a. Without a generic equivalent; or
b. With a generic equivalent where the enrollee has obtained access to the prescription drug through any of the following:
i. Prior authorization;
ii. A step therapy protocol; and
iii. The health care insurer's exceptions and appeals process. (Sec. 1)
2. Defines generic equivalent. (Sec. 1)
3. Contains an effective date of January 1, 2020. (Sec. 2)
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Fifty-fourth Legislature HB 2166
First Regular Session Version 4: Senate Engrossed
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