Pennsylvania HB 2652: An Act amending Title 40 (Insurance) of the Pennsylvania Consolidated Statutes, providing for prescription drug cost credits in health insurance; and imposing penalties.

Bill Text

PRIOR PRINTER'S NO. 3661 PRINTER'S NO. 3707
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 2652
Session of
2026
INTRODUCED BY KINKEAD, McNEILL, PROBST, GUZMAN, HOWARD, SANCHEZ,
HOHENSTEIN, DEASY, OTTEN, D. WILLIAMS AND CIRESI,
JUNE 18, 2026
AS REPORTED FROM COMMITTEE ON INSURANCE, HOUSE OF
REPRESENTATIVES, AS AMENDED, JUNE 24, 2026
AN ACT
Amending Title 40 (Insurance) of the Pennsylvania Consolidated
Statutes, providing for prescription drug cost credits in
health insurance; and imposing penalties.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Title 40 of the Pennsylvania Consolidated
Statutes is amended by adding a chapter to read:
CHAPTER 52
PRESCRIPTION DRUG COST CREDITS IN HEALTH INSURANCE
Sec.
5201. Scope of chapter.
5202. Definitions.
5203. Prescription drug cost credit requirement.
5204. Exceptions.
5205. Protections.
5206. Submission process.
5207. Notice.
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5208. Exemption.
5209. Regulations.
5210. Enforcement.
§ 5201. Scope of chapter.
This chapter relates to the crediting of out-of-pocket costs
paid for prescription drugs toward health plan cost-sharing.
§ 5202. Definitions.
The following words and phrases when used in this chapter
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Commissioner." The Insurance Commissioner of the
Commonwealth.
"Cost-sharing." As follows:
(1) The share of the health care costs covered by a
health benefit plan that a covered person pays out-of-pocket.
(2) The term includes deductibles, coinsurance,
copayments and similar charges.
(3) The term does not include premiums, balance billed
amounts from an out-of-network health care provider or the
cost of noncovered services except as specified in this
chapter.
"Covered person." A policyholder, subscriber or other
individual who is entitled to receive health care services under
a health benefit plan.
"Generically equivalent drug." As defined in section 2 of
the act of November 24, 1976 (P.L.1163, No.259), known as the
Generic Equivalent Drug Law.
"Health benefit plan." As defined in section 103 of the act
of November 21, 2016 (P.L.1318, No.169), known as the Pharmacy
Audit Integrity and Transparency Act.
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"Health care provider." A person who is licensed, certified
or otherwise regulated to provide health care services under the
laws of this Commonwealth.
"Health care services." Covered treatment, admission,
procedure, medical supplies and equipment or other services,
including behavioral health, prescribed or otherwise provided or
proposed to be provided by a health care provider to a covered
person for the diagnosis, prevention, treatment, cure or relief
of a health condition, illness, injury or disease under the
terms of a health benefit plan.
"Health insurer." As defined in section 103 of the Pharmacy
Audit Integrity and Transparency Act.
"Health insurer client." As defined in section 103 of the
Pharmacy Audit Integrity and Transparency Act.
"Interchangeable biological product." As defined in section
2 of the Generic Equivalent Drug Law.
"Out-of-network provider." A health care provider who does
not contract with a health insurer client to provide health care
services to a covered person under a health benefit plan.
"Pharmacy benefits manager." As defined in section 103 of
the Pharmacy Audit Integrity and Transparency Act.
"Prescription drug." The term shall include:
(1) A drug, a generically equivalent drug, a biological
product or an interchangeable biological product, as those
terms are defined in section 2 of the Generic Equivalent Drug
Law, that is prescribed by a health care provider.
(2) Insulin, insulin syringes and insulin needles.
"Prescription drug coverage administrator." A health benefit
plan, health insurer or a pharmacy benefits manager that
administers pharmacy benefits for a health insurer client.
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§ 5203. Prescription drug cost credit requirement.
(a) Credits.--Except as provided in subsection (d), a
prescription drug coverage administrator shall credit toward the
covered person's in-network out-of-pocket maximum and other
cost-sharing requirements an out-of-pocket expense that the
covered person incurs by directly purchasing a prescription drug
from a pharmacy or through a discount drug purchasing entity.
(b) Application of credit.--The credit shall be applied to
the covered person's in-network out-of-pocket maximum for the
plan year in which the out-of-pocket expense is incurred and
without regard to whether:
(1) the pharmacy or discount drug purchasing entity has
a contract or other arrangement with the prescription drug
coverage administrator of the covered person's health benefit
plan; or
(2) the health benefit plan has a separate out-of-
network