Provide requirements for health carriers or pharmacy benefit managers regarding out-of-pocket maximums and cost-sharing requirements

LB 158 requires Nebraska health insurance plans and pharmacy benefit managers to count all payments made by patients (or others on their behalf) toward their annual out-of-pocket maximum. This includes copays, deductibles, and costs for services like prescriptions, ensuring all such payments reduce the yearly limit patients must pay before full coverage kicks in. The law applies to new or renewed health plans after January 1, 2026, with a limited exception for health savings accounts that must first meet a minimum deductible before counting toward the maximum (though preventive care always counts). It directly affects health plan enrollees by clarifying how their out-of-pocket costs are calculated.