Insurers would count outside drug payments toward patients’ payment limits

Insurers and companies that manage prescription benefits would count payments by patients and others toward patients’ required share of costs and out-of-pocket limits. The rule covers prescriptions approved for coverage, whether covered through medical or prescription benefits. The patient’s share includes copays, deductibles, and coinsurance—the percentage of a bill the patient pays. If counting payments would make a patient ineligible for a health savings account or catastrophic health plan under federal law, the rule would apply only after the patient meets the deductible—the amount required before certain insurance payments begin. The rule would take effect January 1, 2027, and apply to health plans offered, issued, or renewed on or after that date.