Kansas Senate Bill SB423

Kansas 2025-2026 Regular Session

• Filed/Introduced: 8/8/26
• Introduced: 1/29/26
• Refer: 1/30/26

Caption

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.

Summary

SB 423 would require Kansas health insurers, pharmacy benefits managers, and pharmacy services administrative organizations to count certain third-party cost-sharing assistance toward a covered person’s deductible and annual out-of-pocket maximum for prescription drugs. The bill applies when a drug has no generic, biosimilar, or interchangeable equivalent, and also when a patient uses a brand-name drug after prior authorization, step therapy, or an exceptions/appeals process. In those situations, amounts paid by the patient or on the patient’s behalf for the prescription drug must be included in the person’s cost-sharing accumulation. The bill also clarifies that a covered individual does not have to comply with utilization management processes when those processes are already prohibited under Kansas law or other applicable state law. If applying the new rule would interfere with federal health savings account rules, the bill delays application to the deductible until the federal minimum deductible is met, while preserving immediate application for preventive care. The Kansas insurance commissioner would be required to adopt rules and regulations to implement the measure.

Impact

SB 423 would amend Kansas health insurance and pharmacy benefit practices by changing how cost-sharing assistance is credited toward deductibles and out-of-pocket limits for prescription drugs. It would affect health insurers, PBMs, pharmacy services administrative organizations, and insured consumers, especially those using high-cost brand-name medications or drugs without generic or biosimilar alternatives. The bill would also interact with existing Kansas utilization management and federal HSA rules, requiring administrative implementation by the insurance commissioner.

Sentiment

No committee transcripts or recorded votes were provided, so there is no direct evidence of debate, support, or opposition in the available record. Based on the bill’s structure, the measure appears consumer-protective and aimed at reducing out-of-pocket prescription costs for patients who rely on manufacturer assistance or other third-party help. The absence of voting history or discussion prevents a reliable assessment of legislative momentum or partisan sentiment.

Contention

The main likely points of contention are the bill’s effect on insurer and PBM cost-sharing design, and whether counting third-party assistance toward deductibles could alter premium, utilization, or drug-pricing incentives. Stakeholders representing insurers and pharmacy benefit managers may be concerned about administrative complexity and cost impacts, while patient advocates and consumers are likely to support the measure because it accelerates deductible and out-of-pocket credit for expensive medications. Another possible issue is the bill’s interaction with federal HSA eligibility rules, which requires a carve-out to avoid conflicts with tax-advantaged health savings accounts.