304.17A-164 Limitations on insurers and pharmacy benefit managers regarding cost-sharing for prescription drugs. (1) As used in this section: (a) "Cost sharing" means the cost to an individual insured under a health benefit plan according to any coverage limit, copayment, coinsurance, deductible, or other out-of-pocket expense requirements imposed by the plan; (b) "Insurer" includes: 1. An insurer offering a health benefit plan providing coverage for pharmacy benefits; or 2. Any other administrator of pharmacy benefits under a health benefit plan; (c) "Pharmacy" includes: 1. A pharmacy, as defined in KRS Chapter 315; 2. A pharmacist, as defined in KRS Chapter 315; or 3. Any employee of a pharmacy or pharmacist; and (d) "Pharmacy benefit manager" has the same meaning as in KRS 304.17A-161. (2) An insurer issuing or renewing a health benefit plan on or after January 1, 2019, or pharmacy benefit manager shall not: (a) Require an insured purchasing a prescription drug to pay a cost-sharing amount greater than the amount the insured would pay for the drug if he or she were to purchase the drug without coverage under a health benefit plan; (b) Prohibit a pharmacy from discussing any information under subsection (3) of this section; and (c) Impose a penalty on a pharmacy for complying with this section. (3) A pharmacist shall have the right to provide an insured information regarding the applicable limitations on his or her cost-sharing pursuant to this section for a prescription drug. (4) Any amount paid by an insured under subsection (2)(a) of this section shall be attributable toward any annual out-of-pocket maximums under the insured's health benefit plan. Effective: January 1, 2019 History: Created 2018 Ky. Acts ch. 144, sec. 1, effective January 1, 2019.