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SB2933
THE SENATE
S.B. NO.
2933
THIRTY-THIRD LEGISLATURE, 2026
STATE OF HAWAII
A BILL FOR AN ACT
Relating
to Health care Costs
.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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SECTION 1.
�
The legislature finds that the rising costs
of prescription drugs continue to place essential medications out of reach for
many residents of the State, especially those managing chronic conditions such
as diabetes, asthma, and severe allergies.
�
High and unpredictable drug prices directly contribute to medication nonadherence,
avoidable hospitalizations, and long-term health complications that drive up
both public and private health care expenditures.
����
The
legislature further finds that as part of efforts to address health care costs
in the insurance and prescription drug markets, several states, including
Colorado, Maryland, Minnesota, and Oregon, have established prescription drug
affordability boards to evaluate high-cost prescription drugs and set upper
payment limits when appropriate to protect consumers and purchasers.
�
Other state legislatures are currently
working to pass legislation through the National Council of Insurance
Legislators.
�
Illinois' proposed
regulatory framework in particular, as outlined in H.B. No. 1443 (2025),
provides a robust, multifactor affordability model that evaluates medicare price
benchmarks, patient access barriers, state budget impact, manufacturer conduct,
and availability of therapeutic alternatives.
����
The
legislature additionally finds that direct-to-consumer affordability
policies--such as out-of-pocket limits for essential medications and the
prohibition of copayment adjustment programs--provide immediate, tangible
relief to patients while longer-term, systemic affordability tools, such as a
prescription drug affordability board, take effect.
����
The
legislature recognizes that opposition may arise from those who argue that an affordability
board may disrupt market dynamics, discourage drug innovation, or reduce
availability of specialty medications.
�
However, the legislature finds that numerous adaptive measures exist to
combat these risks.
�
For example, access
protections and waiver processes can prevent unintended restrictions on
medications for rare or complex conditions.
�
Drug research and development decisions are also driven primarily by
global market forces, not reimbursement decisions made by a single state.
�
Additionally, medicare negotiations now
establish national price benchmarks that states may fairly consider.
�
Furthermore, a phased implementation
framework, combined with shared rulemaking across state agencies, can prevent
administrative overload and ensure effective adoption of new legislation
establishing a prescription drug affordability board.
����
Accordingly,
the purpose of this Act is to safeguard patient access, strengthen pricing
transparency, and promote long-term sustainability in the delivery of
prescription drugs throughout the State by creating a comprehensive, balanced,
and patient-centered approach to prescription drug affordability that includes:
����
(1)
�
Establishing a prescription drug
affordability board to identify and evaluate high-cost prescription drugs and,
when appropriate, set upper payment limits tied to medicare price benchmarks;
����
(2)
�
Implementing statutory limits on
out-of-pocket costs for certain medications to provide immediate financial
relief to patients;
����
(3)
�
Prohibiting copayment adjustment
programs that prevent financial assistance provided by manufacturers or nonprofit
organizations from counting towards a patient's deductibles and maximum out-of-pocket
amounts;
����
(4)
�
Ensuring that affordability tools do
not impede access to medication for patients with chronic or life‑threatening
conditions; and
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(5)
�
Aligning the State with national drug
pricing trends while protecting the health and financial well-being of its residents.
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SECTION
2.
�
The Hawaii Revised Statutes is
amended by adding a new chapter to title 19 be appropriately designated and to
read as follows:
"
Chapter
Prescription
drug affordability board
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� -1
�
Definitions.
�
As used in this chapter:
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"Board"
means the prescription drug affordability board established pursuant to section
‑2.
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"Department"
means the department of health.
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"Director"
means the director of health.
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"Generic
drug" has the same meaning as the term "authorized generic drug"
is defined in title 21 United States Code section 355.
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"Health insurance carrier" means
any accident and health or sickness insurer governed under article 10A, chapter
431; mutual benefit society governed under article 1, chapter 432; or health
maintenance organization governed under chapter 432D.
����
"Manufacturer"
means any entity engaged in the manufacture of prescription drugs sold or
distributed in the State.
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"Pharmacy benefit manager" has
the same meaning as defined in section 431R-1.
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"Prescription
drug" or "drug" means a drug regulated under title 21 United
States Code section 353(b), including biologics and biosimilars.
����
"Upper
payment limit" means the maximum amount that may be reimbursed or paid for
a prescription drug subject to an affordability determination under this
chapter.
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� -2
�
Prescription drug affordability board;
established.
�
(a)
�
There is established within the department
for administrative purposes only the prescription drug affordability board for
the proper administration and enforcement of this chapter.
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(b)
�
The board shall consist of five voting
members appointed by the governor pursuant to section 26-34 and three ex
officio, nonvoting members.
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(c)
�
Voting members shall possess expertise in one
or more of the following areas:
����
(1)
�
Health care economics;
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(2)
�
Clinical medicine or pharmacy practice;
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(3)
�
Health insurance coverage or actuarial
analysis;
����
(4)
�
Public health policy; or
����
(5)
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Consumer health advocacy relating to
prescription drug access.
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(d)
�
No voting member shall be an employee, board
member, or lobbyist of a manufacturer, pharmacy benefit manager, wholesale drug
distributor, or health insurance carrier.
����
(e)
�
The following shall serve as ex officio,
nonvoting members:
����
(1)
�
The director of health or the
director's designee;
����
(2)
�
The director of human services or the
director's designee; and
����
(3)
�
The insurance commissioner or the
commissioner's designee.
����
(f)
�
The board shall select a chairperson from
among its voting members.
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� -3
�
Meetings; quorum; voting.
�
(a)
�
The board shall meet at least quarterly and may hold additional meetings
as the board deems necessary.
����
(b)
�
A majority of the voting members of the board
shall constitute a quorum to do business and the concurrence of at least three
voting members shall be necessary to make any action of the board valid.
����
(c)
�
Meetings of the board shall be conducted
subject to chapter 92; provided that the board may enter an executive meeting
pursuant to section 92-4 or 92-5(8) to receive proprietary or confidential
pricing data submitted by a manufacturer, health insurance carrier, or pharmacy
benefit manager.
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� -4
�
Powers and duties of the board.
�
The board shall:
����
(1)
�
Identify prescription drugs that may create
affordability challenges for patients, purchasers, or the State;
����
(2)
�
Conduct affordability reviews of identified
prescription drugs;
����
(3)
�
Make affordability determinations;
����
(4)
�
Recommend and, where authorized under
this chapter, establish upper payment limits tied to medicare price benchmarks;
����
(5)
�
Analyze the impact of prescription drug
prices on state and county expenditures, including medicaid and public employee
health benefits; and
����
(6)
�
Consult affected stakeholders,
including patients, health care providers, health insurance carriers,
pharmacies, and manufacturers.
����
� -5
�
Staffing; administrative support.
�
(a)
�
The board may employ staff, including analysts, economists, pharmacists,
or other subject matter experts, as necessary to assist the board in performing
its duties.
����
(b)
�
The board may contract for professional
services, including actuarial analysis and clinical review, to support its affordability
review process.
����
(c)
�
The department shall provide administrative support to the board.
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� -6
�
Data submission; confidentiality;
data-sharing agreements.
�
(a)
�
Upon request of the board, a manufacturer, health
insurance carrier, or pharmacy benefit manager shall submit to the board
pricing, rebate, utilization, or other cost data necessary for the board to
conduct an affordability review.
����
(b)
�
The board shall maintain the confidentiality
of proprietary information received pursuant to this section to the extent
permitted under state law; provided that the board may publish aggregated
findings that do not disclose individual contract terms or pricing.
����
(c)
�
The board may enter into data-sharing
agreements with other states' prescription drug affordability boards or pricing
authorities to support multistate analysis and price benchmarking.
����
� -7
�
Affordability review of prescription drugs;
identification; determination; criteria.
�
(a)
�
The board shall conduct a
review of prescription drugs to identify drugs that may require an
affordability review to determine whether the prescription drug presents an
affordability challenge for patients or purchasers in the State.
�
A prescription drug may be subject to an
affordability review pursuant to this section if it meets one or more of the
following criteria:
����
(1)
�
The drug has a wholesale acquisition
cost of $30,000 or more per year or per course of treatment;
����
(2)
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The drug has experienced a wholesale
acquisition cost increase of more than fifteen per cent in a single year or
more than forty per cent over any three-year period;
����
(3)
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The drug is a generic or off-patent
drug that has experienced a wholesale acquisition cost increase of more than
two hundred per cent in a twelve-month period;
����
(4)
�
The drug is a new-to-market drug with a
launch price substantially higher than therapeutic alternatives or medicare price
benchmarks; or
����
(5)
�
The department of human services or the
Hawaii employer-union health benefits trust fund has reported a significant increase
in state expenditure for the drug.
����
(b)
�
In conducting an affordability review of a
prescription drug, the board may consider:
����
(1)
�
Medical necessity and the severity of
the disease or condition treated by the drug;
����
(2)
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The availability, effectiveness, and
cost of therapeutic alternatives;
����
(3)
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The extent to which the drug addresses
an unmet medical need;
����
(4)
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The impact of the drug's cost on
patient adherence and access; and
����
(5)
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Any additional factors the board deems
relevant to the public interest.
����
(c)
�
After completing an affordability review, the
board shall determine whether the prescription drug is unaffordable in the
State by applying a multi-factor rubric, which shall include:
����
(1)
�
Price benchmarking, which shall
consider whether the drug's price exceeds the medicare part D negotiated prices
for plans issued for medicare recipients in the State or the medicare maximum
fair price for the drug negotiated pursuant to title 42 United States Code
section 1320f or other nationally recognized benchmarks by thirty per cent or
more;
����
(2)
�
State spending impact, which shall
consider whether expenditures for the drug contribute significantly to
medicaid, public employee health benefits, or other state health program cost
trends;
����
(3)
�
Patient access data, which shall
consider documented cases of high out-of-pocket costs, nonadherence, financial
hardship, or utilization drop-off attributable to drug cost;
����
(4)
�
Manufacturer conduct, which shall
consider whether the manufacturer has engaged in patterns of unjustified price
increases, anti-competitive behavior, or failure to justify cost increases upon
request of the board; and
����
(5)
�
Availability of alternatives, which
shall consider whether generic, biosimilar, or therapeutic equivalents are
available and clinically appropriate;
provided that, in addition to the
price benchmarks in paragraph (1),
�
t
he
board may consider national and international pricing data in an affordability
determination, including prices in jurisdictions with drug price negotiation or
regulation.
����
� -8
�
Upper payment limits; authority; medicare
reference pricing.
�
(a)
�
If the board determines that a prescription
drug is unaffordable in the State pursuant to section -7, the
board may establish an upper payment limit for that drug.
����
(b)
�
The upper payment limit shall be based on, to
the extent practicable:
����
(1)
�
The medicare part D negotiated price for the
drug for plans issued for medicare recipients in the State;
����
(2)
�
The medicare maximum fair price for the
drug negotiated pursuant to title 42 United States Code section 1320f; or
����
(3)
�
A percentage of the medicare price benchmark
reflecting market conditions of the State.
����
(c)
�
The board shall adopt rules establishing the
methodology for calculating upper payment limits, including:
����
(1)
�
Adjustments for dispensing fees, supply
chain costs, and other reasonable administrative expenses; and
����
(2)
�
A requirement that upper payment limits
apply uniformly across all payers regulated by the State, including health
insurance carriers.
����
(d)
�
In adopting an upper payment limit, the board
shall:
����
(1)
�
Consult with patient advocacy organizations,
clinicians, and other stakeholders as to whether an upper payment limit will
affect patient access to treatment;
����
(2)
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Issue public notice of the proposed
limit;
����
(3)
�
Conduct at least one public hearing;
����
(4)
�
Solicit written input from affected
stakeholders including patients, health care providers, pharmacies, health
insurance carriers, and manufacturers; and
����
(5)
�
Publish its final determination regarding the
upper payment limit for the prescription drug, which shall include a summary of
the evidence and analysis supporting its determination and responses to
stakeholder comments.
����
(e)
�
An upper payment limit established pursuant
to this section shall not apply to any drug:
����
(1)
�
Used to treat a rare disease for which
no therapeutic alternative exists, unless the board determines that applying
the limit will not restrict patient access;
����
(2)
�
For which the manufacturer demonstrates
that application of the limit would result in withdrawal from the state market;
or
����
(3)
�
Administered exclusively in inpatient
hospital settings.
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� -9
�
Administrative priorities; patient access.
�
(a)
�
In
administering this chapter, the board shall ensure that affordability measures,
including upper payment limits, do not impede patient access to medically
necessary prescription drugs.
����
(b)
�
The board shall prioritize:
����
(1)
�
Preserving access to chronic care
medications needed for diabetes, asthma, severe allergies, cardiovascular
disease, mental health conditions, and other long-term illnesses;
����
(2)
�
Not disrupting treatment regimens for
patients who rely on complex or specialty medication;
����
(3)
�
Ensuring continuity of care for
vulnerable populations, including kupuna, individuals with disabilities, and
low-income residents; and
����
(4)
�
Preventing discriminatory impacts on
patients with rare, pediatric, or life-threatening conditions.
����
� -10
�
Waivers and variances.
�
(a)
�
A
manufacturer, health insurance carrier, pharmacy, or pharmacy benefit manager
may apply to the board for a waiver or variance from an upper payment limit.
����
(b)
�
Upon proper filing of an application, the
board shall conduct a hearing in accordance with sections 91-9, 91-9.5, 91‑10,
91-11, 91-12, and 91-13, as applicable.
����
(c)
�
Notwithstanding any law to the contrary,
notice of the hearing, together with a copy of the application, shall be served
on the director and insurance commissioner.
�
In addition, notice of the hearing shall be mailed to all persons who
have made a timely written request for advance notice of waivers or variances
from upper payment limits, and public notice shall be given at least once
statewide at least thirty days in advance of the hearing.
����
(d)
�
Notwithstanding any law to the contrary,
state agencies and persons may intervene in the proceedings in accordance with
rules adopted by the board; provided that the applicant, the department, and
the insurance commissioner shall appear as parties in every case and make
recommendations relative to the waiver or variance.
����
(e)
�
The board may grant a waiver or variance from
an upper payment limit if the applicant demonstrates, with supporting evidence,
that:
����
(1)
�
Application of the upper payment limit
would jeopardize patient access to the prescription drug;
����
(2)
�
Compliance with the upper payment limit
is not feasible due to supply chain or market conditions unique to the State;
����
(3)
�
The applicant is unable to procure the
prescription drug at a cost consistent with the upper payment limit despite
good-faith negotiation efforts;
����
(4)
�
The prescription drug is used to treat
a rare disease or other condition for which no therapeutic alternative exists;
or
����
(5)
�
The waiver or variance is otherwise
necessary to protect the health and safety of state residents.
����
(f)
�
The board, by publication of its findings of
fact and conclusions of law, together with its decision and order, shall act to
approve the application, deny the application, or modify the application by
imposing conditions necessary to uphold the purpose and intent of this chapter.
����
(g)
�
A waiver or variance granted pursuant to this
section shall remain in effect for a period specified by the board in its decision
and order, and may be renewed with good cause.
����
(h)
�
The board shall adopt rules pursuant to
chapter 91 establishing:
����
(1)
�
Application procedures for a waiver or
variance;
����
(2)
�
Required supporting documentation;
����
(3)
�
Timeframes for board action;
����
(4)
�
Intervention
procedures for state agencies and persons; and
����
(5)
�
Conditions for renewal, modification,
or revocation of waivers and variances.
����
� -11
�
Appeals.
�
(a)
�
Any person aggrieved by a
final decision of the board under this chapter may appeal the decision to the
circuit court of the first circuit pursuant to section 91-14.
����
(b)
�
The filing of an appeal shall not stay the
effectiveness of an upper payment limit or other board action unless ordered by
the court for good cause shown.
����
� -12
�
Enforcement; penalty; attorney general.
�
(a)
�
The
board shall monitor compliance with upper payment limits or waivers or
variances therefrom, established or granted pursuant to this chapter.
����
(b)
�
Any health insurance carrier, pharmacy
benefit manager, or pharmacy that violates an upper payment limit or waivers or
variances granted by the board shall be subject to administrative penalties
established by the board by rule; provided that penalties under this subsection
shall not exceed $1,000 per violation per day.
����
(c)
�
A manufacturer that withdraws a prescription
drug from the state market in retaliation for the establishment of an upper
payment limit shall be subject to:
����
(1)
�
A civil penalty of not more than
$25,000 per day; and
����
(2)
�
A public notice identifying the
manufacturer and prescription drug.
����
(d)
�
The board may refer repeated or intentional
violations to the attorney general for enforcement of this section.
����
� -13
�
Interagency coordination.
�
(a)
�
The
board shall collaborate with the department of human services, the Hawaii
employer-union health benefits trust fund, the insurance division of the
department of commerce and consumer affairs, and other state agencies as
appropriate to carry out its duties under this chapter.
����
(b)
�
All state agencies shall provide the board,
upon request and to the extent permitted by law, data and technical assistance
necessary for conducting affordability reviews.
����
(c)
�
The board may recommend statutory or
regulatory changes to improve data collection, transparency, and oversight of
prescription drug pricing.
����
� -14
�
Annual reports.
�
The board shall submit a report of its
administration of this chapter to the legislature no later than twenty days
prior to the convening of each regular session, including:
����
(1)
�
A list of the prescription drugs
reviewed and affordability determinations issued by the board in the preceding
year;
����
(2)
�
Any upper payment limits established by
the board in the preceding year and the rationale for each upper payment limit;
����
(3)
�
Any waivers or variances from upper payment
limits granted by the board in the preceding year;
����
(4)
�
Data on changes in drug spending and
patient access through the preceding year;
����
(5)
�
A summary of stakeholder concerns and
recommendations received by the board in the preceding year; and
����
(6)
�
Other findings and recommendations,
including proposed legislation or regulations.
����
� -15
�
Rules.
�
The board shall adopt rules pursuant to chapter 91 necessary to carry
out the purposed of this chapter."
����
SECTION
3.
�
Chapter 431, Hawaii Revised Statutes,
is amended by adding three new sections to article 10A to be appropriately
designated and to read as follows:
����
"
�431:10A-A
�
Prescription drugs; out-of-pocket maximum.
�
(a)
�
Each individual and group accident
and health or sickness insurance policy, contract, plan, or agreement issued or
renewed after December 31, 2026, that includes coverage or benefits for
prescription drugs shall comply with the following requirements:
����
(1)
�
Cost-share for prescription insulin drugs
shall not exceed $35 for a thirty-day supply, inclusive of all forms and
delivery devices;
����
(2)
�
Cost-share for a portable
prescription drug delivered by inhalation and approved by the United States
Food and Drug Administration for treatment or management of asthma shall not
exceed $50 per inhaler, regardless of the quantity or dosage; provided that
this paragraph shall not prohibit a covered person from choosing a
higher-priced inhaler; and
����
(3)
�
Cost-share for a package of two
single-use prescription automatic injector devices that contain epinephrine and
are approved by the United States Food and Drug Administration for the
emergency treatment of life-threatening allergic reactions, including
anaphylaxis, shall not exceed $60.
����
(b)
�
Every insurer shall provide notice to its
policyholders regarding the maximum cost-share amount required by this
section.
�
The notice shall be in writing
and prominently positioned in any literature or correspondence sent to
policyholders and shall be transmitted to policyholders within calendar year 2027
when annual information is made available to
policyholders
or in any other mailing to
policyholders
, but in no case later than December 31, 2027
.
����
(c)
�
Nothing in this section shall prevent an
insurer from offering lower cost-sharing amounts or waiving cost-sharing
entirely for covered prescription drugs.
����
(d)
�
As used in this section,
"cost-share" or "cost‑sharing" includes copayment,
coinsurance, and deductible provisions applicable to coverage for medications
or treatments.
����
�431:10A-B
�
Copayment adjustment programs; prohibited.
�
(a)
�
Every insurer shall apply all third-party payments, including
manufacturer copayment assistance or assistance from nonprofit patient
assistance programs, toward a covered person's maximum cost-share amount,
unless prohibited by federal law.
����
(b)
�
No insurer shall implement a copayment
adjustment program or any similar policy that disregards third-party payments
for the purpose of calculating a covered person's cost‑sharing
obligations.
����
(c)
�
The commissioner shall adopt rules pursuant
to chapter 91 to implement this section.
����
(d)
�
As used in this section, "cost-share" or "cost‑sharing"
includes copayment, coinsurance, and deductible provisions applicable for
coverage for medications or treatments.
����
�431:10A-C
�
Prescription drug upper payment limits;
compliance.
�
(a)
�
Every insurer shall comply with any upper
payment limit established or a waiver or variance therefrom granted by the
prescription drug affordability board pursuant to chapter .
����
(b)
�
No insurer shall reimburse a pharmacy,
prescriber, or patient for a prescription drug subject to an upper payment
limit established pursuant to chapter in an amount greater
than the upper payment limit.
����
(c)
�
Nothing in this section shall prohibit an insurer
from negotiating a lower reimbursement rate.
"
����
SECTION
4.
�
Chapter 432, Hawaii Revised Statutes,
is amended by adding three new sections to article 1 to be appropriately
designated and to read as follows:
����
"
�432:1-
�
Prescription drugs; out-of-pocket maximum.
�
(a)
�
Notwithstanding any law to the contrary, each individual and group hospital
or medical service plan contract issued or renewed in this State after
December 31, 2026,
that includes coverage or
benefits for p
rescription drugs shall comply with the
following requirements:
����
(1)
�
Cost-share
for prescription insulin drugs shall not exceed $35 for a thirty-day supply,
inclusive of all forms and delivery devices;
����
(2)
�
Cost-share
for a portable prescription drug delivered by inhalation and approved by the
United States Food and Drug Administration for treatment or management of asthma
shall not exceed $50 per inhaler, regardless of the quantity or dosage;
provided that this paragraph shall not prohibit a member from choosing a higher‑priced
inhaler; and
����
(3)
�
Cost-share
for a package of two single-use prescription automatic injector devices that
contain epinephrine and are approved by the United States Food and Drug
Administration for the emergency treatment of life-threatening allergic
reactions, including anaphylaxis, shall not exceed $60.
����
(b)
�
Every mutual benefit society shall
provide notice to its members regarding the maximum cost-share amount required
by this section.
�
The notice shall be in
writing and prominently positioned in any literature or correspondence sent to
members and shall be transmitted to members within calendar year 2027 when
annual information is made available to members or in any other mailing to
members, but in no case later than December 31, 2027.
����
(c)
�
Nothing in this section shall prevent a mutual
benefit society from offering lower cost-sharing amounts or waiving cost-sharing
entirely for covered prescription drugs.
����
(d)
�
For the purposes of this section,
"cost-share" or "cost-sharing" includes copayment,
coinsurance, and deductible provisions applicable to coverage for medications
or treatments.
����
�432:1-
�
Copayment adjustment programs; prohibited.
�
(a)
�
Every mutual benefit society shall apply all third-party payments, including
manufacturer copayment assistance or assistance from nonprofit patient
assistance programs, toward a covered person's maximum cost-share amount,
unless prohibited by federal law.
����
(b)
�
No mutual benefit society shall implement a
copayment adjustment program or any similar policy that disregards third‑party
payments for the purpose of calculating a covered person's cost-sharing
obligations.
����
(c)
�
The commissioner shall adopt rules pursuant
to chapter 91 to implement this section.
����
(d)
�
For the purposes of this section,
"cost-share" or "cost-sharing" includes copayment,
coinsurance, and deductible provisions applicable to coverage for medications
and treatments.
����
�432:1-
�
Prescription drug upper payment limits;
compliance.
�
(a)
�
Every mutual benefit society shall comply
with any upper payment limit established or a waiver or variance therefrom
granted by the prescription drug affordability board pursuant to chapter
.
����
(b)
�
No mutual benefit society shall reimburse a
pharmacy, prescriber, or patient for a prescription drug subject to an upper
payment limit established pursuant to chapter , in an amount greater
than the upper payment limit.
����
(c)
�
Nothing in this section shall prohibit a
mutual benefit society from negotiating a lower reimbursement rate.
"
����
SECTION
5.
�
Chapter 432D, Hawaii Revised
Statutes, is amended by adding a new section to be appropriately designated and
to read as follows:
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�432D-
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Prescription drugs; out-of-pocket maximum;
copayment assistance; upper payment limits.
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(
a)
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Each policy, contract,
plan, or agreement issued in the State after December 31, 2026, by health
maintenance organizations pursuant to this chapter, that includes coverage or
benefits for prescription drugs shall comply with the maximum cost-share
requirements for prescription drugs established in section 431:10A-A.
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(b)
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Every health maintenance
organization shall apply all third-party copayment assistance toward an
enrollee's maximum cost-share amount in accordance with section 431:10A-B.
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(c)
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Every health maintenance
organization shall comply with any upper payment limits established or a waiver
or variance therefrom granted by the prescription drug affordability board
pursuant to chapter .
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(d)
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The commissioner may enforce
compliance with this section pursuant to chapter 431 and rules adopted pursuant
to chapter 91.
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SECTION
6.
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There is appropriated out of the
general revenues of the State of Hawaii the sum of $500,000 or so much thereof
as may be necessary for fiscal year 2026-2027 to establish and administer the
prescription drug affordability board, including:
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(1)
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The
establishment and hiring of positions as deemed necessary by the department of
health;
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(2)
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Contracting
of data systems, actuarial analysis, and clinical review services; and
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(3)
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Conducting stakeholder engagement,
rulemaking, and public hearings required under this Act.
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The
sum appropriated shall be expended by the department of health for the purposes
of this Act.
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SECTION 7.
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In codifying the new sections added by section 3 of this Act, the
revisor of statutes shall substitute appropriate section numbers for the
letters used in designating the new sections in this Act.
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SECTION 8.
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This Act does not affect rights and duties that matured, penalties that
were incurred, and proceedings that were begun before its effective date.
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SECTION
9.
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New statutory material is
underscored.
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SECTION 10.
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This Act shall take effect on July 1, 2026.
INTRODUCED
BY:
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Report Title:
DOH; Insurance
Commissioner; Health Care; Costs; Prescription Drug Affordability Board; Upper
Payment Limits; Out-of-Pocket Maximums; Copayment Adjustment Programs; Reports;
Rules; Appropriation
Description:
Establishes
the Prescription Drug Affordability Board within the Department of Health to
conduct affordability reviews on high-cost prescription drugs and establish
upper payment limits under certain circumstances.
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Establishes out-of-pocket maximums for
prescribed insulin, asthma inhalers, and epinephrine auto-injectors.
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Prohibits copayment adjustment programs.
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Requires health insurers, mutual benefit
societies, and health maintenance organizations to comply with certain
affordability measures.
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Requires annual
reports to the Legislature.
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Requires
adoption of rules by the Affordability Board and Insurance Commissioner.
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Appropriates funds.
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.