Health Benefit Plans - Calculation of Cost-Sharing Contribution - Requirements

SB 773 requires Maryland health insurers, pharmacy benefit managers, and plan administrators to count all cost-sharing payments made by patients (or others on their behalf) toward their annual out-of-pocket limits and deductibles. It specifically prohibits "accumulator adjustment programs" that exclude patient assistance payments from counting toward these limits, which currently force patients to pay twice for medications after meeting their deductible. This affects patients enrolled in high-deductible health plans who rely on prescription drug cost assistance programs. The bill directly changes how insurers calculate cost-sharing by mandating that all patient payments count toward annual limits, not just those paid directly to the insurer.