Section 1, Section 31A-22-662 is enacted to read:31A-22-662. Cost sharing requirements for health benefit plans.(1)As used in this section:(a)(i)"Cost sharing requirement" means any copayment, coinsurance, deductible, or annual limitation on cost sharing required by a health benefit plan for a specific health care service covered by the health benefit plan.(ii)"Cost sharing requirement" includes any copayment, coinsurance, deductible, or annual limitation that is subject to 42 U.S.C. Sec. 18022(c) or 300gg-6(b).(b)"Qualifying health benefit plan" means a health benefit plan that:(i)allows the full value of available copay assistance to reduce the out-of-pocket costs of an enrollee;(ii)includes, when two or more individuals are covered, an individual maximum out-of-pocket that is not greater than 50% of the health benefit plan's combined total maximum out-of-pocket for family coverage;(iii)after the deductible has been met, only requires payment by the enrollee at the equivalent of the plan's lowest payment tier for any drug that has been subject to copay assistance and that copay assistance has been exhausted; and(iv)for a covered lower cost drug that an enrollee is required to take under the plan instead of a covered higher cost drug for which copay assistance reduces the enrollee's out-of-pocket costs to a negligible amount, the plan:(A)only requires payment by the enrollee of the preferred drug at the equivalent of the plan's lowest payment tier; and(B)may share cost savings due to the lower cost drug with the enrollee, including while the enrollee is subject to a deductible.(2)Except as provided in Subsection (3), when calculating an enrollee's contribution to any applicable cost sharing requirement for a covered prescription drug or device, an insurer shall include any cost sharing amounts paid:(a)by the enrollee; or(b)using a drug discount coupon.(3)An insurer may refuse to apply a drug discount coupon to an enrollee's applicable cost sharing requirement for the drug or device that is eligible for the drug discount coupon if:(a)the drug or device that is eligible for the drug discount coupon has:(i)a generic alternative; or(ii)a biological product, as defined in 42 U.S.C. Sec. 262, that:(A)has been approved by the federal Food and Drug Administration to treat the enrollee's condition;(B)is not eligible for a drug discount coupon; and(C)is subject to the health benefit plan's lowest copay tier for biologic products; or(b)the enrollee has not obtained a necessary approval from the health benefit plan to have the drug covered by the health benefit plan or has not completed the necessary requirements, restrictions, or clinical criteria to obtain the approval.(4)This section:(a)applies to any health benefit plan entered into, amended, extended, or renewed on or after July 1, 2026; and(b)does not apply to a qualifying health benefit plan.(5)The commissioner may make rules in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, to implement this section.