ARIZONA HOUSE OF REPRESENTATIVES

HB 2166: unfair claims practices; cost sharing

NOW: health plans; cost sharing; calculation

PRIME SPONSOR: Representative Barto, LD 15

BILL STATUS: Transmitted to Governor

Overview

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 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. Contains an effective date of January 1, 2020. (Sec. 2)

3. Defines health care insurer and generic equivalent. (Sec. 1)

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Fifty-fourth Legislature                           HB 2166

First Regular Session                Version 5: Transmitted

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