SB 443 — NO CHOLESTEROL-LOWERING DRUG COST SHARING

SENATE TAX, BUSINESS AND TRANSPORTATION COMMITTEE SUBSTITUTE FOR SENATE HEALTH AND PUBLIC AFFAIRS COMMITTEE SUBSTITUTE FOR SENATE BILL 443 5757TH THLEGISLATURE LEGISLATUR--STATEOFNEWMEXICO- STATE OF NEW MEXICO - FIRST SESSIO,SESSION, 2025 4 6 8 10 AN ACT RELATING TO INSURANCE;

AMENDING THE HEALTH CARE PURCHASING ACT AND SECTIONS OF THE NEW MEXICO INSURANCE CODE TO PROHIBIT COST SHARING FOR GENERIC MEDICATIONS USED FOR THE TREATMENT OF CHOLESTEROL DISORDER.DISORDER AND SECOND-LINE STEP THERAPY MEDICATIONS UNDER CERTAIN CIRCUMSTANCES;

16EXCEPTING BECERTAIN ITPLANS. ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

e t 17 SECTIONBE 1.IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

A new section of the Health Care Purchasing w l n d 18 ActSECTION is1. enacted to read:

=A =new 19section aof lthe "[NEWHealth MATERIAL]Care COVERAGEPurchasing FOR= MEDICATIONS= USED19 FOR THE i a el rAct 20is TREATMENTenacted OFto CHOLESTEROLread: DISORDER.-- a t m m 21 A.

Groupi healtha coverage,e including any form of d r e20 22"[NEW self-insurance,MATERIAL] offered,COVERAGE issuedFOR orMEDICATIONS renewedUSED underFOR theTHE Healtha ct em sm k21 23TREATMENT CareOF PurchasingCHOLESTEROL ActDISORDER.-- thatd providesr coverage for cholesterol- e a22 nA. b 24 lowering medications shall not impose cost sharing on those u [ medications.

.231444.1Group SHPAC/SBhealth coverage, including any form of c e s k 23 self-insurance, offered, issued or renewed under the Health e a n b 24 Care Purchasing Act that provides coverage for cholesterol- u [ lowering medications shall not impose cost sharing on generic .231810.1 STBTC/SHPAC/SB 443 B.medications.

B.

If generic medications fail to lower cholesterol in the blood to below sixty milligrams per deciliter or generate adverse reactions not tolerated by the patient, as determined by the prescribing health care provider, cost sharing shall not be imposed on second-line step therapy medications.

C.

D.

The provisions of this section do not apply to excepted benefit plans as provided pursuant to the Short-Term Health Plan and Excepted Benefit Act, catastrophic plans as e t 17 defined pursuant to 42 USCA Section 18022(e) or high-deductible w l n d 18 health plans with health savings accounts until an eligible = = 19 insured's deductible has been met, unless otherwise allowed a l i a e r 20 pursuant to federal law." a t m m 21 SECTION 2.

A new section of Chapter 59A, Article 22 NMSA d r e 22 1978 is enacted to read:

c e s k 23 "[NEW MATERIAL] COVERAGE FOR MEDICATIONS USED FOR THE e a n b 24 TREATMENT OF CHOLESTEROL DISORDER.-- u [ A.

An individual or group health insurance policy, .231810.1 - 2 - STBTC/SHPAC/SB 443 health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state that provides coverage for cholesterol-lowering medications shall not impose cost sharing on generic medications.

B.

If generic medications fail to lower cholesterol in the blood to below sixty milligrams per deciliter or generate adverse reactions not tolerated by the patient, as determined by the prescribing health care provider, cost sharing shall not be imposed on second-line step therapy medication.

TheFor provisionsthe purposes of this sectionsection, do"cost notsharing" applymeans toa exceptedcopayment, benefitcoinsurance, plansa asdeductible providedor pursuantany toother theform Short-Termof Healthfinancial Planobligation andof Exceptedthe Benefitenrollee Act,other catastrophicthan plansa aspremium definedor pursuanta toshare 42of USCAa Sectionpremium, 18022(e) or highany deductiblecombination healthof plansany withof healththese savingsfinancial accountsobligations, untilas defined by the terms of an eligibleindividual insured'sor deductiblegroup hashealth beeninsurance met,policy, unlesshealth otherwisecare allowedplan pursuantor toe federalt law."17 SECTIONcertificate 2.of health insurance.

Aw newl sectionn ofd Chapter18 59A,D. Article 22 NMSA 1978 is enacted to read:

"[NEWThe MATERIAL]provisions COVERAGEof FORthis MEDICATIONSsection USEDdo FORnot THEapply to = = 19 excepted benefit plans as provided pursuant to the Short-Term a l i a e r 20 Health Plan and Excepted Benefit Act, catastrophic plans as a t 17m TREATMENTm OF21 CHOLESTEROLdefined DISORDER.--pursuant wto l42 nUSCA Section 18022(e) or high-deductible d 18r A.e 22 health plans with health savings accounts until an eligible c e s k 23 insured's deductible has been met, unless otherwise allowed e a n b 24 pursuant to federal law." u [ SECTION 3.

AnA individualnew orsection groupof healthChapter insurance59A, policy,Article =23 =NMSA 19.231810.1 health- care3 plan- orSTBTC/SHPAC/SB certificate443 of health insurance that is aenacted lto iread: a e r 20 delivered, issued for delivery or renewed in this state that a t m m 21 provides coverage for cholesterol-lowering medications shall d r e 22 not impose cost sharing on those medications.

c e s k 23 B.

For the purposes of this section, "cost e a n b 24 sharing" means a copayment, coinsurance, a deductible or any u [ other form of financial obligation of the insured other than a .231444.1 - 2 - SHPAC/SB 443 premium or a share of a premium, or any combination of any of these financial obligations, as defined by the terms of an individual or group health insurance policy, health care plan or certificate of health insurance.

C.

The provisions of this section do not apply to excepted benefit plans as provided pursuant to the Short-Term Health Plan and Excepted Benefit Act, catastrophic plans as defined pursuant to 42 USCA Section 18022(e) or high deductible health plans with health savings accounts until an eligible insured's deductible has been met, unless otherwise allowed pursuant to federal law." SECTION 3.

A new section of Chapter 59A, Article 23 NMSA is enacted to read:

A group or blanket health insurance policy, e t 17 health care plan or certificate of health insurance that is w l n d 18 delivered, issued for delivery or renewed in this state that = = 19 provides coverage for cholesterol-lowering medications shall a l i a e r 20 not impose cost sharing on thosegeneric medications.

a t m m 21 B.

ForIf thegeneric purposesmedications offail thisto section,lower "costcholesterol sharing"in dthe rblood eto 22below meanssixty amilligrams copayment,per coinsurance,deciliter a deductible or anygenerate otheradverse formreactions cnot etolerated sby kthe 23patient, of financial obligation of a covered person other than a e a n b 24 premium or a share of a premium, or any combination of any of u [ these financial obligations, as defineddetermined by the termsprescribing ofhealth acare groupprovider, .231444.1cost -sharing 3shall -not SHPAC/SBbe 443imposed oron blanketsecond-line healthstep insurancetherapy policy,medications. health care plan or certificate of health insurance.

TheFor provisionsthe purposes of this sectionsection, do"cost notsharing" applymeans toa exceptedcopayment, benefitcoinsurance, plansa asdeductible providedor pursuantany toother theform Short-Terme Healtht Plan17 andof Exceptedfinancial Benefitobligation Act,of catastrophican plansinsured other than a premium or a w l n d 18 share of a premium, or any combination of any of these = = 19 financial obligations, as defined pursuantby tothe 42terms USCAof Sectiona 18022(e)group or higha deductiblel healthi plansa withe healthr savings20 accountsblanket untilhealth aninsurance eligiblepolicy, insured'shealth deductiblecare hasplan beenor met,a unlesst otherwisem allowedm pursuant21 tocertificate federalof law."health SECTIONinsurance. 4.

d r e 22 D.

The provisions of this section do not apply to c e s k 23 excepted benefit plans as provided pursuant to the Short-Term e a n b 24 Health Plan and Excepted Benefit Act, catastrophic plans as u [ defined pursuant to 42 USCA Section 18022(e) or high-deductible .231810.1 - 4 - STBTC/SHPAC/SB 443 health plans with health savings accounts until an eligible insured's deductible has been met, unless otherwise allowed pursuant to federal law." SECTION 4.

An individual or group health maintenance organization contract that is delivered, issued for delivery or renewed in this state that provides coverage for cholesterol- e t 17 lowering medications shall not impose cost sharing on thosegeneric w l n d 18 medications.

= = 19 B.

If generic medications fail to lower cholesterol in the blood to below sixty milligrams per deciliter or generate adverse reactions not tolerated by the patient, as determined by the prescribing health care provider, cost e t 17 sharing shall not be imposed on second-line step therapy w l n d 18 medications.

= = 19 C.

u [ C.D.

The provisions of this section do not apply to .231444.1.231810.1 - 45 - SHPAC/SBSTBTC/SHPAC/SB 443 excepted benefit plans as provided pursuant to the Short-Term Health Plan and Excepted Benefit Act, catastrophic plans as defined pursuant to 42 USCA Section 18022(e) or highhigh-deductible deductible health plans with health savings accounts until an eligible insured's deductible has been met, unless otherwise allowed pursuant to federal law." SECTION 5.

An individual or group health care plan that is delivered, issued for delivery or renewed in this state that provides coverage for cholesterol-lowering medications shall not impose cost sharing on thosegeneric medications.