H 4492
An Act relative to patient financial protection
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Sign in to take action- Introduced
- Passed House
- Passed Senate
- To Governor
- Became Law
Bill overview
This bill establishes a limit on out-of-pocket expenses for prescription drug coverage in Massachusetts health insurance policies, contracts, and certificates. Specifically, the maximum out-of-pocket cost for prescription drugs, including specialty drugs, will be tied to the minimum annual deductible for high-deductible health plans as determined by federal law. This applies to various types of health insurance plans, including those offered by health maintenance organizations.
Key provisions
- Sets a maximum out-of-pocket limit for prescription drug expenses in health insurance plans.
- The limit is tied to the minimum annual deductible for high-deductible health plans under federal law.
- The limit includes specialty drugs.
- Applies to policies, contracts, and certificates issued or renewed within Massachusetts.
- Covers various types of health insurance plans, including health maintenance organizations.
- The provisions apply starting January 1, 2026.
Who is affected
- Health insurance policyholders
- Healthcare providers
- Health insurance companies
- Patients
- Pharmaceutical companies
Notable changes
- Establishes a specific out-of-pocket limit for prescription drug costs, rather than relying on existing cost-sharing arrangements.
- Links the out-of-pocket limit to a federal standard (high-deductible health plan deductible).
Sponsors
Official sponsors from legislative records.
Primary sponsor
Joint Committee on Financial Services
Cosponsors
Estela A. Reyes
Marjorie C. Decker
Arguments in favor
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Bill H.4492 194th (Current)
An Act relative to patient financial protection
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Bill Information
Bill Information
Sponsor: Joint Committee on Financial Services Status: Referred to Joint Committee on Health Care Financing
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Bill History Cosponsors Committee Vote Committee Summary
Bill History
Displaying 5 actions for Bill H.4492
| Date | Branch | Action |
| 9/18/2025 | House | Reported from the committee on Financial Services |
| 9/18/2025 | House | New draft of H1133 |
| 9/18/2025 | House | Reported favorably by committee and referred to the committee on Health Care Financing |
| 12/8/2025 | House | Reporting date extended to Wednesday, March 18, 2026 |
| 3/19/2026 | House | Reporting date extended to Monday, June 15, 2026 |
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