HB 625: Health insurance; limit on cost-sharing payments for prescription drugs under certain plans.

Official summary

Abstract published by the legislature (via Open States). Text as published by the legislature; reproduced verbatim.

Health insurance; limit on cost-sharing payments for prescription drugs under certain plans. Requires each carrier that offers a health plan in either the individual or small group market to ensure that at least one health plan in each of the bronze, silver, gold, and platinum levels of coverage in each rating area in the individual and small group market conform with the following: (i) a plan that offers a platinum level of coverage shall limit a person's cost-sharing payment for prescription drugs covered under the plan to an amount that does not exceed $150 per 30-day supply of the prescription drug; (ii) a plan that offers a gold level of coverage shall limit a person's cost-sharing payment for prescription drugs covered under the plan to an amount that does not exceed $200 per 30-day supply of the prescription drug; (iii) a plan that offers a silver level of coverage shall limit a person's cost-sharing payment for prescription drugs covered under the plan to an amount that does not exceed $250 per 30-day supply of the prescription drug; and (iv) a plan that offers a bronze level of coverage shall limit a person's cost-sharing payment for prescription drugs covered under the plan to an amount that does not exceed $300 per 30-day supply of the prescription drug. The bill requires that any plans offered to meet its requirements are (a) clearly and appropriately named to aid the consumer or plan sponsor in the plan selection process and (b) marketed in the same manner as other plans offered by the carrier. The bill's provisions apply to any individual or group accident and sickness insurance policy, any individual or group accident and sickness subscription contract, and any health care plan for health care services delivered, issued for delivery, or renewed in the Commonwealth on or after January 1, 2028. This bill is identical to SB 161.

Sponsors

Sponsors by party (alphabetical): Democratic 2

“Support” is shown only as formal sponsorship recorded by the legislature. Roll-call votes are available on the official bill page.

Recent official actions

1. April 13, 2026Acts of Assembly Chapter text (CHAP0641)
2. April 13, 2026Approved by Governor-Chapter 641 (effective 7/1/2026)
3. April 13, 2026Fiscal Impact Statement from State Corporation Commission (HB625)
4. March 31, 2026Governor's Action Deadline 11:59 p.m., April 13, 2026
5. March 31, 2026Enrolled Bill communicated to Governor on March 31, 2026
6. March 31, 2026Signed by Speaker
7. March 30, 2026Signed by President
8. March 30, 2026Bill text as passed House and Senate (HB625ER)
9. March 30, 2026Enrolled
10. March 11, 2026Conference report agreed to by Senate (39-Y 0-N 0-A)
11. March 10, 2026Conference report agreed to by House (63-Y 33-N 0-A)
12. March 10, 2026Conference Report released

Showing 12 most recent of 40 actions. Full history