Representative Karls proposes ban on insurer accumulator policies for certain high-cost prescription drugs; lawmakers debate fairness and scope

Representative Karen Karls introduced House Bill 1216, which would require health benefit plans to count amounts paid by third parties on behalf of an enrollee — for specified high-cost prescription drugs that have no generic equivalent — toward the enrollee’s deductible and out-of-pocket maximum. Karls framed the bill with a constituent story: a patient with a rare disease who received manufacturer assistance at the pharmacy but later was billed the same amount because the insurer did not credit the manufacturer payment to the…