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Committee adopts amendment to HB 12-16 on copay-accumulator treatment, holds bill for more fiscal data
Summary
The House Industry, Business and Labor Committee adopted an amendment to House Bill 12-16 that removes grandfathered plans from the bill's fiscal note. Members asked the insurance department for more data and held the bill for follow-up.
The House Industry, Business and Labor Committee adopted an amendment to House Bill 12-16 on Tuesday, then held the measure for additional fiscal analysis and information from the state Insurance Department.
Representative Kathy Carls, the bill sponsor, told the committee the amendment removes a "grandfathered" plan from the bill's fiscal note, which she said would reduce a previously estimated biennial fiscal impact that she recalled as about $8 million. Carls said the change targets co-pay accumulator programs that prevent third-party payments from counting toward a patient's out-of-pocket deductible, a practice she said particularly affects people with rare diseases who rely on manufacturer assistance.
The amendment was moved by Representative Ruby and seconded by Representative Casper; the committee adopted the amendment by voice vote. Earlier the committee moved to reconsider its prior action on the bill (motion to reconsider moved by Representative Koppelman, seconded by Representative Schauer), which carried.
A spokesman from the North Dakota Insurance Department, Crystal Bartuska, joined the hearing remotely to give the committee preliminary context on grandfathered plans in the state. Bartuska said PERS (the public employees' retirement plan) remains grandfathered and that most remaining grandfathered plans are in the large-group market; she offered to obtain concrete counts of grandfathered plans from carriers. Committee members asked the department to supply a formal count and for actuaries to recalculate the fiscal note based on the adopted amendment.
Committee members pressed on how third-party assistance is processed at pharmacies and through pharmacy benefit managers, with some members saying transaction flows are opaque and that PBMs keep detailed information confidential. Representative Ruby argued the practical effect of the amendment is to reduce coverage for many commercial plans; Representative Johnson and others emphasized the measure's intent to protect patients whose assistance should apply to deductibles.
The committee agreed to hold HB 12-16 until the Insurance Department and the actuary provide further information and to notify interested parties.
The hearing record shows the committee adopted the amendment and that staff will secure additional fiscal and market information before further action.
