→
Previous
Latest
PRIOR PRINTER'S NO.
PRINTER'S NO.
3661 PRINTER'S NO.
3661 THE GENERAL ASSEMBLY OF PENNSYLVANIA HOUSE BILL Session of No.
3707 THE GENERAL ASSEMBLY OF PENNSYLVANIA HOUSE BILL Session of No.
WILLIAMS AND CIRESI, JUNE 18, 2026 AS REPORTED FROM COMMITTEE ON INSURANCE, HOUSE OF REPRESENTATIVES, AS AMENDED, JUNE 24, 2026 AN ACT Amending Title 40 (Insurance) of the Pennsylvania Consolidated Statutes, providing for prescription drug cost credits in health insurance;
WILLIAMS AND CIRESI, JUNE 18, 2026 REFERRED TO COMMITTEE ON INSURANCE, JUNE 22, 2026 AN ACT Amending Title 40 (Insurance) of the Pennsylvania Consolidated Statutes, providing for prescription drug cost credits in health insurance;
20260HB2652PN3707 - 2 - "Health care provider." A person who is licensed, certified or otherwise regulated to provide health care services under the laws of this Commonwealth.
"Health care provider." A person who is licensed, certified 20260HB2652PN3661 - 2 - or otherwise regulated to provide health care services under the laws of this Commonwealth.
20260HB2652PN3707 - 3 - § 5203.
§ 5203.
(a) Credits.--Except as provided in subsection (d), a prescription drug coverage administrator shall credit toward the covered person's in-network out-of-pocket maximum and other cost-sharing requirements an out-of-pocket expense that the covered person incurs by directly purchasing a prescription drug from a pharmacy or through a discount drug purchasing entity.
20260HB2652PN3661 - 3 - (a) Credits.--Except as provided in subsection (d), a prescription drug coverage administrator shall credit toward the covered person's in-network out-of-pocket maximum and other cost-sharing requirements an out-of-pocket expense that the covered person incurs by directly purchasing a prescription drug from a pharmacy or through a discount drug purchasing entity.
(2) The amount the covered person would have incurred if the covered person had obtained the same prescription drug in 20260HB2652PN3707 - 4 - the same plan year from an in-network pharmacy and under the terms of the covered person's health benefit plan.
(2) The amount the covered person would have incurred if the covered person had obtained the same prescription drug in the same plan year from an in-network pharmacy and under the 20260HB2652PN3661 - 4 - terms of the covered person's health benefit plan.
Nothing in this chapter shall require a health benefit plan to credit the cost share of a prescription drug in derogation of a policyholder's constitutional protections of religious freedom 20260HB2652PN3707 - 5 - under:
Nothing in this chapter shall require a health benefit plan to credit the cost share of a prescription drug in derogation of a policyholder's constitutional protections of religious freedom under:
(1) The act of December 9, 2002 (P.L.1701, No.214), known as the Religious Freedom Protection Act.
20260HB2652PN3661 - 5 - (1) The act of December 9, 2002 (P.L.1701, No.214), known as the Religious Freedom Protection Act.
20260HB2652PN3707 - 6 - (4) May require submission of satisfactory proof of purchase, including evidence of the purchase date and amount and the identification of the prescription drug purchased.
(4) May require submission of satisfactory proof of 20260HB2652PN3661 - 6 - purchase, including evidence of the purchase date and amount and the identification of the prescription drug purchased.
(a) Exemption.--The requirements of this chapter shall not apply to a prescription drug coverage administrator that contracts or has an arrangement with a pharmacy or discount drug purchasing entity that makes available a transparent pricing model to covered persons, if the prescription drug coverage administrator makes available all drugs covered under the terms 20260HB2652PN3707 - 7 - of the covered person's health benefit plan that are offered from that pharmacy or discount drug purchasing entity as part of the contract or arrangement with the health benefit plan.
(a) Exemption.--The requirements of this chapter shall not apply to a prescription drug coverage administrator that contracts or has an arrangement with a pharmacy or discount drug purchasing entity that makes available a transparent pricing model to covered persons, if the prescription drug coverage administrator makes available all drugs covered under the terms of the covered person's health benefit plan that are offered 20260HB2652PN3661 - 7 - from that pharmacy or discount drug purchasing entity as part of the contract or arrangement with the health benefit plan.
(B) LOSS OF EXEMPTION.--A PRESCRIPTION DRUG COVERAGE <-- ADMINISTRATOR THAT NO LONGER QUALIFIES FOR THE EXEMPTION UNDER THIS SECTION SHALL COMPLY WITH ALL APPLICABLE REQUIREMENTS OF THIS CHAPTER WITHIN 60 DAYS AFTER THE DATE ON WHICH THE PRESCRIPTION DRUG COVERAGE ADMINISTRATOR FAILS TO MEET THE REQUIREMENTS FOR THE EXEMPTION, WHICH MAY BE EXTENDED AT THE DISCRETION OF THE COMMISSIONER.
(b) Definitions.--As used in this section, the following words and phrases shall have the meanings given to them in this subsection unless the context clearly indicates otherwise:
(b) (C) Definitions.--As used in this section, the following <-- words and phrases shall have the meanings given to them in this subsection unless the context clearly indicates otherwise:
20260HB2652PN3707 - 8 - § 5209.
§ 5209.
(1) Suspension or revocation of the offending entity's license or registration.
20260HB2652PN3661 - 8 - (1) Suspension or revocation of the offending entity's license or registration.
20260HB2652PN3707 - 9 - (3) The act of June 25, 1997 (P.L.295, No.29), known as the Pennsylvania Health Care Insurance Portability Act.
(3) The act of June 25, 1997 (P.L.295, No.29), known as the Pennsylvania Health Care Insurance Portability Act.
A party against whom penalties are assessed in an administrative action may appeal to Commonwealth Court as provided in 2 Pa.C.S.
A party against whom penalties are assessed in an administrative 20260HB2652PN3661 - 9 - action may appeal to Commonwealth Court as provided in 2 Pa.C.S.
20260HB2652PN3707 - 10 -
20260HB2652PN3661 - 10 -
⬇ Download PDF