Section 48-855.02b - Calculation of member's contributions for a prescription drug covered under the health benefit plan.(a) Except as otherwise provided in subsection (b) of this section, when calculating a member's contribution to their coinsurance, copayment, cost-sharing responsibility, deductible, or out-of-pocket maximum under the member's health benefit plan, the health insurer shall include any discount, financial assistance payment, product voucher, or any other out-of-pocket expense made by or on behalf of the member for a prescription drug covered under the member's health benefit plan that:(1) Is without a generic drug equivalent or an interchangeable biological product preferred under the health benefit plan's formulary; or(2) Has a generic equivalent drug or an interchangeable biological product preferred under the health benefit plan's formulary where the member has obtained access to the drug through prior authorization, a step therapy protocol, or the exception or appeal process of the health insurer or pharmacy benefits manager.(b) Subsection (a) of this section shall not apply to a member covered by a high deductible health plan, as that term is defined under 26 U.S.C. § 223, until the member satisfies their minimum deductible; except, that subsection (a) of this section shall apply to contribution amounts made for preventative care, as that term is defined under 26 U.S.C. § 223 (c)(2)(C). (c) This section shall apply to health benefit plans entered into, amended, extended, or renewed on or after January 1, 2025. Added by D.C. Law 25-26,§ 2, 70 DCR 007912, eff. 7/20/2023.