Posted: April 20, 2021
On March 25, 2021, Kentucky Governor Andy Beshear signed SB 45 into law. The law prevents the indiscriminate use of accumulator adjustment programs for state regulated plans in Kentucky and is the seventh such accumulator law in the United States.
CSRO thanks the Kentuckiana Rheumatology Alliance, its members, and everyone who advocated for the passage of this bill! Your actions directly impacted the success of this legislation.
What’s in the bill?
SB 45 requires health plans and pharmacy benefit managers (PBM) to count any amounts paid by an insured or on behalf of an insured towards their contribution to any cost-sharing requirements of their insurance plan, such as a deductible.
However, a plan or PBM may still exclude co-pay assistance from counting towards an insured’s cost-sharing obligations if a generic alternative is available. This caveat does not apply if the brand name drug was pre-authorized, was obtained by completing a step therapy protocol, or obtained through the exceptions and appeals process.
When will it go into effect?
The law will go into effect on January 1, 2022.
What plans will the law apply to?
The law will apply to individual and fully-insured group commercial policies sold in Kentucky. State employee plans are not covered by the law.
How can I tell what type of plan my patient has?
To be sure, contact the state Department of Insurance at 502-564-3630.
Helpful tip: If an insurance card says the policy is “underwritten by” the insurer, then the plan is likely an individual or group insurance policy regulated by the state. If the card says the policy is “administered by” the insurer or “administrative services only” (ASO), then the plan is likely a self-funded plan not subject to state insurance laws.
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