Legislative Update

We are currently planning for our Virtual Legislative Day later this spring. With the support of OSMA, we hope to meet with legislators to provide feedback on several current legislative items.

Non-medical switching (HB 153)

Legislation that would prohibit insurers from engaging in the practice of non-medical switching. This occurs when patients are forced to switch to a less expensive treatment in the middle of a plan year for no medical reason. This disrupts a physician’s ability to exercise their medical expertise and help their patients.

Copay accumulator (HB 135)

Health plans and pharmacy benefit managers (PBMs) may apply co-pay accumulator adjustment policies when patients attempt to use copay assistance programs. These prohibit a patient’s copay assistance amount from count toward their deductible and maximum out-of-pocket cap. The bill would require insurers and PBMs to count all payments made by patients directly or on their behalf toward their deductibles and out-of-pocket costs, increasing predictability as vulnerable patients face high out-of-pocket costs for their prescriptions.

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