Includes any costs paid by an enrollee or on behalf of the enrollee, by a third party when calculating an enrollee’s overall contribution to any out-of-pocket maximum or cost sharing requirement, under a health plan as of January 1, 2027.
Impact
The implications of S2253 on state laws are significant, particularly concerning the insurance regulation landscape in Rhode Island. By mandating that insurance calculations include all applicable costs—such as those paid out of pocket or covered by third parties—the bill is poised to enhance consumer protection and transparency in the healthcare system. It could also address inequities faced by patients who struggle with rising prescription drug costs by providing a clearer framework for understanding their financial responsibilities.
Summary
Bill S2253 aims to amend Rhode Island's General Laws pertaining to insurance, particularly focusing on 'Prescription Drug Benefits.' The essence of this bill is to calculate the overall contribution of an enrollee towards out-of-pocket maximums or cost-sharing requirements under a health plan. The proposed provisions will account for any costs paid by the enrollee or third parties on their behalf, ensuring a more comprehensive approach in determining what amounts count towards an enrollee's expense limits from January 1, 2027, onward.
Contention
While the intent behind S2253 is largely focused on improving consumer outcomes in the context of healthcare costs, the bill may spark debates regarding its implementation. Opponents may argue that it places additional burdens on insurers and pharmacy benefit managers to comply with these stringent calculations. Furthermore, concerns may arise surrounding the implications for health savings account eligibility under federal law if these changes inadvertently disqualify certain plans or coverage options, creating a potential friction point between state and federal regulations.
Includes any costs paid by an enrollee or on behalf of the enrollee by a third party when calculating an enrollee’s overall contribution to any out-of-pocket maximum or cost sharing requirement under a health plan as of January 1, 2026.
Includes any costs paid by an enrollee or on behalf of the enrollee by a third party when calculating an enrollee’s overall contribution to any out-of-pocket maximum or cost sharing requirement under a health plan as of January 1, 2026.
Prohibits prior authorization or a step therapy protocol for the prescription of a nonpreferred medication on their drug formulary used to assess or treat an enrollee's bipolar disorder, schizophrenia or schizotypal.
Creates the Rhode Island Individual Market Affordability Act of 2024 to help reduce out-of-pocket costs for low- and moderate-income consumers enrolled in the health insurance coverage through the Rhode Island health benefits exchange.
Creates the Rhode Island Individual Market Affordability Act of 2024 to help reduce out-of-pocket costs for low- and moderate-income consumers enrolled in the health insurance coverage through the Rhode Island health benefits exchange.
Sets controls on Medicaid prescription drug costs by imposing transparency and accountability requirements on managed care organizations (MCOs) and their pharmacy benefit managers (PBMs).
Sets controls on Medicaid prescription drug costs by imposing transparency and accountability requirements on managed care organizations (MCOs) and their pharmacy benefit managers (PBMs).
Includes manufactured homes on leased land under a long-term lease in excess of thirty (30) years at the time of enrollment within the classification of affordable housing.
Includes manufactured homes on leased land under a long-term lease in excess of thirty (30) years at the time of enrollment within the classification of affordable housing.
Requires every individual or group health insurance contract effective on or after January 1, 2026, to provide coverage to the insured and the insured's spouse and dependents for all FDA-approved contraceptive drugs, devices and other products.