Requiring certain cost-sharing assistance be applied toward a covered individual's deductible or annual out-of-pocket limit under the individual's health benefit plan.

Session of 2026
SENATE BILL No. 423
By Senator Sykes
1-29
AN ACT concerning health insurance; relating to cost-sharing
requirements; requiring certain cost-sharing assistance be applied
toward a covered individual's deductible or annual out-of-pocket limit
under the individual's health benefit plan.
Be it enacted by the Legislature of the State of Kansas:
Section 1. (a) As used in this section:
(1) "Cost-sharing requirement" means any copayment, coinsurance,
deductible or annual limitation on cost sharing, including a limitation
subject to 42 U.S.C. § 18022(c) or 42 U.S.C. § 300gg-6(b), required by or
on behalf of a covered individual in order to receive a prescription drug
covered by the covered individual's health benefit plan whether covered as
a medical or pharmacy benefit.
(2) "Health benefit plan" means the same as defined in K.S.A. 40-
2209d, and amendments thereto.
(3) "Health insurer" means the same as defined in K.S.A. 40-4602,
and amendments thereto.
(4) "Pharmacy benefits manager" means a person, business or other
entity that performs pharmacy benefits management. "Pharmacy benefits
manager" includes any person or entity acting in a contractual or
employment relationship for a pharmacy benefits manager in the
performance of pharmacy benefits management for a covered entity.
"Pharmacy benefits manager" does not include a covered insurance entity.
(5) "Pharmacy services administrative organization" means an entity
operating within Kansas that contracts with one or more independent
pharmacies to conduct business with third-party payers on behalf of such
independent pharmacy to provide administrative services to the
independent pharmacy and negotiate and enter into contracts with third-
party payers or pharmacy benefits managers on behalf of the independent
pharmacy.
(b) When calculating a covered individual's overall contribution to an
out-of-pocket maximum or cost-sharing requirement under the covered
individual's health benefit plan, a health insurer, pharmacy benefits
manager or pharmacy administrative services organization shall include
any amount paid by the covered individual or by another person on behalf
of the covered individual for a prescription drug if:
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SB 423 2
(1) The prescription drug does not have a generic equivalent or, for a
prescription drug that is a biological product, the prescription drug does
not have a biosimilar drug, as defined in 42 U.S.C. § 262(i)(2), or an
interchangeable biological product, as defined in 42 U.S.C. § 262(i)(3); or
(2) the prescription drug has a generic equivalent, a biosimilar drug or
an interchangeable biological product and the covered individual is using
the brand-name prescription drug after:
(A) Obtaining prior authorization from the carrier, pharmacy benefits
manager or pharmacy administrative services organization;
(B) complying with a step-therapy protocol required by the health
benefit plan, pharmacy benefits manager or pharmacy administrative
services organization; or
(C) receiving approval from the health benefit plan, pharmacy
benefits manager or pharmacy administrative services organization
through such health benefit plan's, pharmacy benefit manager's or
pharmacy administrative service organization's exceptions, appeal or
review process.
(c) A covered individual shall not be required to comply with the
utilization management processes described in article 22a of chapter 40 of
the Kansas Statutes Annotated, and amendments thereto, including prior
authorization and step-therapy protocol requirements, when such processes
are otherwise prohibited under chapter 40 of the Kansas Statutes
Annotated, and amendments thereto, or other applicable state law.
(d) If the application of subsection (b) would make a covered
individual's health savings account contributions ineligible under 26
U.S.C. § 223, the provisions of subsection (b) shall apply to the deductible
applicable to the covered individual's health benefit plan after the covered
individual has satisfied the minimum deductible amount under 26 U.S.C. §
223. With respect to items or services that are preventive care pursuant to
26 U.S.C. § 223(c)(2)(C), the provisions of subsection (b) shall apply
regardless of whether the minimum deductible under 26 U.S.C. § 223 has
been satisfied.
(e) The commissioner shall adopt rules and regulations necessary to
implement and administer the provisions of this section.
Sec. 2. This act shall take effect and be in force from and after its
publication in the statute book.
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