District of Columbia § 48-855.02b Calculation of member's contributions for a prescription drug covered under the health benefit plan.

District of Columbia Statutes

§ 48-855.02b — Calculation of member's contributions for a prescription drug covered under the health benefit plan.

District of Columbia § 48-855.02b

Title 48Foods and Drugs.

Ch. 8HSpecialty Drug Copayment Limitation.

This text of District of Columbia § 48-855.02b (Calculation of member's contributions for a prescription drug covered under the health benefit plan.) is published on Counsel Stack Legal Research, covering District of Columbia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

D.C. Code § 48-855.02b (2026).

Text

(a)Except as otherwise provided in subsection (b) of this section, when calculating a member's contribution to their coinsurance, copayment, cost-sharing responsibility, deductible, or out-of-pocket maximum under the member's health benefit plan, the health insurer shall include any discount, financial assistance payment, product voucher, or any other out-of-pocket expense made by or on behalf of the member for a prescription drug covered under the member's health benefit plan that:

(1)Is without a generic drug equivalent or an interchangeable biological product preferred under the health benefit plan's formulary; or

(2)Has a generic equivalent drug or an interchangeable biological product preferred under the health benefit plan's formulary where the member has obtained access to

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(a) Except as otherwise provided in subsection (b) of this section, when calculating a member's contribution to their coinsurance, copayment, cost-sharing responsibility, deductible, or out-of-pocket maximum under the member's health benefit plan, the health insurer shall include any discount, financial assistance payment, product voucher, or any other out-of-pocket expense made by or on behalf of the member for a prescription drug covered under the member's health benefit plan that:

(1) Is without a generic drug equivalent or an interchangeable biological product preferred under the health benefit plan's formulary; or

(2) Has a generic equivalent drug or an interchangeable biological product preferred under the health benefit plan's formulary where the member has obtained access to the drug through prior authorization, a step therapy protocol, or the exception or appeal process of the health insurer or pharmacy benefits manager.

(b) Subsection (a) of this section shall not apply to a member covered by a high deductible health plan, as that term is defined under 26 U.S.C. § 223, until the member satisfies their minimum deductible; except, that subsection (a) of this section shall apply to contribution amounts made for preventative care, as that term is defined under 26 U.S.C. § 223(c)(2)(C).

(c) This section shall apply to health benefit plans entered into, amended, extended, or renewed on or after January 1, 2025.