SB 449 - This act defines "flat-fee drug copayment plan" as a health benefit plan that utilizes a pre-deductible flat-fee copayment structure for the entire drug benefit at all tiers, and does not require a deductible or any coinsurance amount with regard to drug benefits.

No later than January 1, 2020, each health carrier shall ensure that no less than 25% of health benefit plans it offers within each service area and at each metal level, as defined by law, are flat-fee drug copayment plans. If a carrier offers fewer than 4 health benefit plans within a service area or within a service area and metal level, the carrier shall ensure that at least one plan offered is a flat-fee drug copayment plan.

Copayment structures for flat-fee drug copayment plans shall be reasonably graduated and proportionally related in all tier levels such that the copayment structure as a whole does not discriminate against or discourage the enrollment of individuals with significant health care needs.

Carriers shall clearly and appropriately name all flat-fee drug copayment plans to aid consumers and sponsors in selecting a health benefit plan.

Carriers shall market flat-fee drug copayment plans in the same manner as other plans. With regard to group plans, carriers shall ensure that each group or plan sponsor has the option to purchase a flat-fee drug copayment plan.


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