AN ACT relating to prescription drugs.
HB413 would change Kentucky law governing prescription drug cost sharing and pharmacy benefit management for health plans issued or renewed on or after January 1, 2026. The bill requires insured cost sharing for prescription drugs to be calculated at the point of sale and directs that rebates received by insurers, pharmacy benefit managers (PBMs), or other pharmacy benefit administrators be passed through to reduce what insureds pay, with at least 85% of rebates used to lower point-of-sale cost sharing and any remaining rebates used to reduce premiums. It also prohibits an insured from being charged more in cost sharing than the cash price of the drug, limits how cost-sharing payments count toward deductibles or other cost-sharing requirements in certain cases, and preserves pharmacists’ ability to tell patients about applicable cost-sharing limits.
The bill amends multiple Kentucky statutes, including KRS 304.17A-164, 304.17C-125, 304.38A-115, 18A.225, and 164.2871, to make Section 1’s prescription drug cost-sharing rules apply across commercial health plans, limited health service benefit plans, limited health service organizations, the state employee health insurance program, and certain postsecondary institution health plans. It also creates a new trade-secret provision in KRS 365.880 to 365.900 protecting the actual amount of rebates received by insurers and PBMs on a product-, manufacturer-, or pharmacy-specific basis. The bill would affect insurers, PBMs, pharmacies, state employee plans, and public higher education health plans by changing how drug rebates are handled, how patient cost sharing is calculated, and what information may be disclosed.
No committee transcripts or recorded votes were provided, so there is no direct evidence of floor or committee sentiment in the available record. Based on the bill text, the measure appears designed to lower out-of-pocket prescription drug costs for insured patients and increase transparency in how rebates are used, while also protecting rebate amounts as confidential trade secrets. The overall policy direction suggests consumer-cost relief paired with confidentiality protections for industry participants.
The main points of contention likely involve the bill’s mandate that rebates be passed through to reduce patient cost sharing and premiums, which could be opposed by insurers, PBMs, or manufacturers concerned about pricing flexibility, administrative burden, or disclosure obligations. Another likely issue is the trade-secret treatment of rebate amounts, which may draw criticism from transparency advocates even as it protects proprietary pricing information. The bill also contains carve-outs and federal-law limitations, including an exception for high-deductible health plans and a generic-drug exception for certain cost-sharing rules, indicating areas where implementation and compliance may be debated.