Copay accumulator laws by state: where the copay card has to count

We checked the state's insurance code and department and found no accumulator provision as of September 20, 2026.

Not checked against the state's own code this cycle; the trackers we consulted list no law.

When calculating an enrollee's contribution to any out-of-pocket maximum, deductible, copayment, coinsurance or other applicable cost sharing requirement, the health care insurer that provides pharmacy benefits or a pharmacy benefits manager that administers pharmacy benefits for a health care insurer shall include any cost sharing amount paid by either the enrollee or another person on behalf of the enrollee for a prescription drug.

HB2166 (2019). Effective December 31, 2019. Scope: prescription drugs without a generic equivalent, or with a generic equivalent where the enrollee obtained the brand via prior authorization, step therapy, or the insurer's exceptions/appeals process. Generic/biosimilar exception: Does not require counting cost-sharing assistance for a brand drug with a generic equivalent unless the enrollee accessed the brand through prior authorization, a step-therapy protocol, or the insurer's exceptions and appeals process (in which case it must still be counted). Reaches: fully-insured, HMO, PPO.

Only drugs with no generic equivalent — or a generic-equivalent brand accessed via prior authorization, step therapy, or an insurer appeal — must be credited toward the deductible/OOP max.

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When calculating an enrollee's contribution to any applicable cost-sharing requirement, a healthcare insurer shall include any cost-sharing amounts paid by the enrollee or on behalf of the enrollee by another person.

HB1569 (Act 965 of 2021) (2021). Effective January 1, 2022. Scope: all state-regulated individual, blanket, and group health benefit plans (both an insurance-code version at § 23-79-2103 and a parallel HMO-code version at § 23-92-511). Generic/biosimilar exception: Does not apply to cost-sharing for a prescription drug if a name-brand drug is prescribed and that drug (A) is not considered medically necessary by the prescriber AND (B) has a medically appropriate generic equivalent. Reaches: fully-insured, HMO.

Applies to plans entered into, amended, extended, or renewed on/after Jan 1, 2022; excludes Medicaid, workers' comp, and plans with no pharmacy benefit.

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We checked the state's insurance code and department and found no accumulator provision as of September 20, 2026.

No California law requires counting copay assistance toward the deductible/OOP max; AB 874 died in committee 2024-01-31 and no successor bill has passed as of 2026-09-20.

When calculating a covered person's overall contribution to an out-of-pocket maximum or cost-sharing requirement under the covered person's health benefit plan, a carrier or PBM shall include any amount paid by the covered person or by another person on behalf of the covered person for a prescription drug.

SB23-195 (2023). Effective January 1, 2025. Scope: prescription drugs without a generic equivalent/biosimilar/interchangeable biological product, or with one where the covered person is using the brand after prior authorization, a step-therapy protocol, or the carrier's exceptions/appeal/review process. Generic/biosimilar exception: Does not require counting for a brand drug with a generic/biosimilar/interchangeable biological product available unless the covered person is using the brand after prior authorization, step therapy, or an exceptions/appeal/review approval (in which case it must still be counted). Reaches: fully-insured, HMO, PPO.

Applies to plans issued/renewed on/after Jan 1, 2025; HSA-qualified HDHPs must satisfy the federal minimum deductible first (except preventive care).

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For any contract delivered, issued for delivery, renewed, amended or continued in this state on or after January 1, 2022, each managed care organization shall, when calculating an enrollee's liability for a coinsurance, copayment, deductible or other out-of-pocket expense for a covered benefit, give credit for any discount provided or payment made by a third party for the amount of, or any portion of the amount of, the coinsurance, copayment, deductible or other out-of-pocket expense for the covered benefit.

SB 1003 (Public Act No. 21-14) (2021). Effective January 1, 2022. Scope: all state-regulated individual/group health insurance policies (§2, for insurers/health care centers/hospital & medical service corporations/fraternal benefit societies), all managed care plans (§4), and pharmacy-benefit-manager administration contracts (§5) — three parallel operative sections, all effective 2022-01-01. No generic exception in the text. Reaches: fully-insured, HMO, PPO.

CT credits ALL third-party payments with no generic-drug exception — broader than most states' laws, which exempt brand drugs when a generic is available.

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When calculating an enrollee contribution to any applicable cost-sharing requirement, a carrier shall include any cost-sharing amounts paid by the enrollee or on behalf of the enrollee by another person.

Scope: all state-regulated carriers (insurance company, health service corporation, HMO, or other entity providing a health plan subject to state insurance regulation). No generic exception in the text. Reaches: fully-insured, HMO.

Subsection (d) requires crediting third-party cost-sharing; a separate cap in subsection (c) limits what a plan may charge to the lesser of the plan cost, cash price, or contract price — the two are not the same rule.

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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.

D.C. Law 25-26 (Copay Accumulator Amendment Act of 2023) (2023). Effective January 1, 2025. Scope: prescription drugs without a generic equivalent, or with a generic equivalent where the member obtained the brand via prior authorization, step therapy, or the insurer's exceptions/appeal process. Generic/biosimilar exception: Requirement applies to (1) drugs with no generic equivalent, and (2) drugs with a generic equivalent where the member accessed the brand through prior authorization, step therapy, or an exceptions/appeal process. Also carries a high-deductible-health-plan/HSA carve-out: the requirement does not apply to HDHP members until they satisfy the minimum deductible, except for preventive care. Reaches: fully-insured, HMO, PPO.

Applies to plans renewed on/after Jan 1, 2025; amends the pre-existing 2016 specialty-drug copay cap (§48-855.02, a separate $150/30-day cap) — the two provisions are distinct.

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We checked the state's insurance code and department and found no accumulator provision as of September 20, 2026.

No Florida law requires copay-assistance crediting; HB 696/SB 561 (2020) and later attempts have not passed as of 2026-09-20.

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When calculating an insured's contribution to any out-of-pocket maximum, deductible, or copayment responsibility, a pharmacy benefits manager shall include any amount paid by the insured or paid on his or her behalf through a third-party payment, financial assistance, discount, or product voucher for a prescription drug

As quoted by a secondary source; not checked against the state's own statute text this cycle.

SB 313 (2019-2020 session) (2020). Scope: fully-insured plans and HMOs regulated under Title 33 (PBM contracts); Ch. 64 = 'Regulation and Licensure of Pharmacy Benefits Managers'. Generic/biosimilar exception: Applies only to a prescription drug that does not have a generic equivalent, OR that has a generic equivalent but was obtained through prior authorization, a step therapy protocol, or the insurer's exceptions and appeals process. Subsection also states nothing requires a PBM to accept a third-party payment/voucher submitted on an insured's behalf. Reaches: fully-insured, HMO, PPO.

Applies only to drugs without a generic equivalent, or a generic-equivalent brand accessed via prior auth/step therapy/appeal — same structure as AZ/CO/KY; PBM-facing (Title 33 Ch. 64 PBM licensure), not a direct insurer mandate.

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Not checked against the state's own code this cycle; the trackers we consulted list no law.

We checked the state's insurance code and department and found no accumulator provision as of September 20, 2026.

Rep. David Cannon's RS 32178 (chronic-pain/accumulator ban) was introduced but never advanced past House Health & Welfare committee introduction — worth monitoring for reintroduction.

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A health care plan shall apply any third-party payments, financial assistance, discount, product vouchers, or any other reduction in out-of-pocket expenses made by or on behalf of such insured for prescription drugs toward a covered individual's deductible, copay, or cost-sharing responsibility, or out-of-pocket maximum associated with the individual's health insurance.

HB 465 / Public Act 101-0452 (2019). Scope: all Illinois-regulated health care plans (no generic-availability carve-out found in the text obtained). No generic exception in the text. Reaches: fully-insured, HMO, PPO.

No generic-drug exception in Illinois's law — broader than most states', like CT's and Iowa's; effective date is commonly cited elsewhere as 2020-01-01 but is not stated in the primary Act text itself.

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No statute text could be opened for this state this cycle.

HEA 1604 (2025) (2025). Scope: brand-name drugs without an approved generic that manage chronic pain or are 'life-saving' (per secondary reporting -- exact statutory scope not confirmed). Generic/biosimilar exception: Per secondary reporting, the law's scope is limited to brand drugs without a generic that manage chronic pain or are considered life-saving -- this reads as an inclusion criterion rather than a classic generic-availability carve-out; exact statutory text not obtained.

A pharmacy benefits manager shall include any amount paid by a covered person, or on behalf of a covered person, when calculating the covered person's total contribution toward the covered person's cost-sharing.

SF 383 (91st General Assembly) (2025). Effective July 1, 2025. Scope: all state-regulated health benefit plans that use a pharmacy benefits manager (law regulates PBMs, health carriers, and third-party payors directly). No generic exception in the text. Reaches: fully-insured, HMO, PPO.

Iowa credits ALL third-party payments (copay cards, coupons) with no generic-drug carve-out, unlike most other states' laws; effective for drug benefits managed on/after July 1, 2025.

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We checked the state's insurance code and department and found no accumulator provision as of September 20, 2026.

Don't confuse with K.S.A. 40-3831 (Pharmacy Patients Fair Practices Act), which caps copays at the pharmacy's submitted charge but does not require crediting manufacturer copay cards toward the deductible/OOP max.

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Exclude any cost-sharing amounts paid by an insured or on behalf of an insured by another person for a prescription drug, including any amount paid under paragraph (a) of this subsection, when calculating an insured's contribution to any applicable cost-sharing requirement.

SB 45 (2021 Regular Session, Chapter 134) (2021). Effective January 1, 2022. Scope: state-regulated insurers and pharmacy benefit managers issuing/renewing a health plan on or after the effective date. Generic/biosimilar exception: KRS 304.17A-164(2)(b): the crediting requirement 'shall not apply in the case of a prescription drug for which there is a generic alternative, unless the insured has obtained access to the brand prescription drug through prior authorization, a step therapy protocol, or the insurer's exceptions and appeals process.'. Reaches: fully-insured, HMO, PPO.

Excludes the Kentucky state-employee health plan (KRS 18A.225) from the accumulator-crediting rule; effective 2022-01-01.

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A. As used in this Section the following definitions shall apply... B. When calculating an enrollee's contribution to any applicable cost-sharing requirement, a health insurance issuer shall include any cost-sharing amounts paid by the enrollee or on behalf of the enrollee by another person.

SB 94 (2021 Regular Session), Act 431 (2021). Effective June 21, 2021. Scope: all state-regulated health insurance issuers (individual, group, HMO, PPO) issuing health benefit plans in Louisiana. No generic exception in the text. Reaches: fully-insured, HMO, PPO.

No generic-drug or prior-authorization carve-out: unlike ME/MD, Louisiana requires ALL third-party cost-sharing payments to count, for any drug, with no exceptions.

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A carrier or pharmacy benefits manager shall give credit for any waiver or discount of, or payment made by a 3rd party for, the amount of, or any portion of the amount of, the applicable cost-sharing or other out-of-pocket expense for the covered prescription drug.

LD 1783 / SP 621 (130th Legislature), Public Law 2021, c. 744 (2022). Effective January 1, 2023. Scope: all state-regulated carriers and PBMs administering prescription drug benefits under a covered person's health plan in Maine. Generic/biosimilar exception: Applies to a covered prescription drug that either (a) has no generic equivalent, or (b) has a generic equivalent but the covered person obtained access to the brand through prior authorization, a step therapy override, or another exception/appeal process. Outside those two conditions, the crediting requirement does not apply. Reaches: fully-insured, HMO.

For HSA-qualified high-deductible plans, crediting applies to the deductible only after the enrollee meets the IRS §223 minimum deductible (except IRS-defined preventive care, which is exempt from that limit).

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When calculating an insured's or enrollee's contribution to the insured's or enrollee's coinsurance, copayment, deductible, or out-of-pocket maximum under the insured's or enrollee's health benefit plan, an entity subject to this section shall include any discount, financial assistance payment, product voucher, or other out-of-pocket expense made by or on behalf of the insured or enrollee for a prescription drug.

SB 773 (companion HB 1246), 2025 Regular Session, Chapter 692 (2025). Effective January 1, 2026. Scope: insurers, nonprofit health service plans, and HMOs providing hospital/medical/surgical benefits under policies or contracts issued or delivered in Maryland; also binds administrators (as defined in Ins. §8-301) alongside carriers under §15-118.1(C); also directly binds PBMs administering pharmacy benefits on behalf of a carrier (new §15-1611.3). Generic/biosimilar exception: Applies to a covered prescription drug that either (a) does not have an AB-rated generic equivalent drug or interchangeable biological product preferred on the plan's formulary, or (b) does have one, but the insured/enrollee originally obtained coverage for the brand through prior authorization, a step therapy protocol, or the carrier's exception/appeal process. Reaches: fully-insured, individual, group, HMO, nonprofit health service plan.

Not permanent: Chapter 692 sunsets automatically 2029-07-01 (3 yrs 6 mo after its 2026-01-01 effective date) unless the legislature re-enacts it. HDHP/HSA deductibles are exempt until the IRS §223 minimum deductible is met (preventive care excepted).

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We checked the state's insurance code and department and found no accumulator provision as of September 20, 2026.

We checked the state's insurance code and department and found no accumulator provision as of September 20, 2026.

Read the source →

We checked the state's insurance code and department and found no accumulator provision as of September 20, 2026.

Not checked against the state's own code this cycle; the trackers we consulted list no law.

We checked the state's insurance code and department and found no accumulator provision as of September 20, 2026.

We checked the state's insurance code and department and found no accumulator provision as of September 20, 2026.

We checked the state's insurance code and department and found no accumulator provision as of September 20, 2026.

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an issuer is not allowed to exclude Rx coupons from cost-sharing limits except in situations where a generic is available.

Scope: ACA-regulated individual and small-group 'health benefit plans' filed with the NV Division of Insurance under its annual Plan Year filing guidance (SERFF filers); not a large-group or self-funded ERISA mandate. Generic/biosimilar exception: An issuer may exclude Rx coupons from cost-sharing limits only in situations where a generic equivalent is available. Reaches: fully-insured, individual, small group.

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We checked the state's insurance code and department and found no accumulator provision as of September 20, 2026.

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When calculating an enrollee's contribution to any applicable cost-sharing amount requirement, a carrier or third-party administrator shall give credit for the amount, or any portion thereof, of any cost-sharing amount paid by the enrollee or on behalf of the enrollee by another party.

A5217 ("Ensuring Fairness in Cost-Sharing Amounts Act of 2025") (2026). Effective April 9, 2026. Scope: all carrier-issued health benefits plans (individual, small group, large group) and PBM-administered plans in NJ. No generic exception in the text. Reaches: fully-insured, HMO.

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When calculating an insured's cost-sharing obligation for covered prescription drugs, pursuant to an individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state, the insurer shall credit the insured for the full value of any discounts provided or payments made by third parties at the time of the prescription drug claim.

SB 51 (2023). Scope: all state-regulated individual and group health insurance policies, HMO contracts, nonprofit health care plans, and group health plans purchased under the Health Care Purchasing Act. No generic exception in the text. Reaches: fully-insured, HMO, individual, group.

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Any policy that provides coverage for prescription drugs shall apply any third-party payments, financial assistance, discount, voucher or other price reduction instrument for out-of-pocket expenses made on behalf of an insured individual for the cost of prescription drugs to the insured's deductible, copayment, coinsurance, out-of-pocket maximum, or any other cost-sharing requirement when calculating such insured individual's overall contribution.

A1741-A (S5299-A) (2022). Effective January 1, 2023. Scope: individual accident and health policies (§3216(i)(37)), group/blanket policies (§3221(l)(21)), and contracts issued by Article 43 corporations — nonprofit medical/hospital/health service corporations e.g. Empire BlueCross-type insurers (§4303(tt)); does not amend Public Health Law §4406-c, so HMO-specific coverage under PHL Article 44 was not independently confirmed. No generic exception in the text. Reaches: fully-insured, individual, group.

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When calculating an insured's contribution to any out-of-pocket maximum, deductible, copayment, coinsurance, or other applicable cost-sharing requirement, the insurer or pharmacy benefits manager shall include any amounts paid by the insured, or on the insured's behalf, for a prescription that is either: (1) Without an AB-rated generic equivalent.

SB 257 (2021). Effective October 1, 2021. Scope: all state-regulated health benefit plans (excludes the State Health Plan for Teachers and State Employees). Generic/biosimilar exception: Applies only when the prescription has no AB-rated generic equivalent, OR has a generic equivalent but the insured obtained the brand through prior authorization, a step-therapy protocol, or the insurer's/PBM's exception or appeal process. Reaches: fully-insured, HMO, PPO.

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an insurer may not deliver, issue, execute, or renew a health benefit plan providing prescription drug coverage unless when calculating an enrollee's overall contribution to any out-of-pocket maximum or any cost-sharing requirement for a prescription drug under the health benefit plan, the health benefit plan provides for the inclusion of any amount paid by the enrollee or paid on behalf of the enrollee by another person.

HB 1216 (2025). Effective January 1, 2026. Scope: all state-regulated health benefit plans, plus the Public Employees Retirement System uniform group insurance program; the act also amends N.D.C.C. § 26.1-36.6-03 to extend the new requirement to self-insurance health plans that are subject to the state Insurance Commissioner's jurisdiction. Generic/biosimilar exception: Applies to prescription drugs with no generic equivalent, or with a generic equivalent if the enrollee obtained access via prior authorization, a step-therapy protocol, or the insurer's exceptions/appeals process; also bars varying the OOP max/cost-sharing or otherwise designing benefits based on the availability of a cost-sharing assistance program. Reaches: fully-insured, HMO.

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We checked the state's insurance code and department and found no accumulator provision as of September 20, 2026.

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As a health insurer that provides pharmacy benefits or a pharmacy benefits manager that administers pharmacy benefits for a health plan, failing to include any amount paid by an enrollee or on behalf of an enrollee by another person when calculating the enrollee's total contribution to an out-of-pocket maximum, deductible, copayment, coinsurance or other cost-sharing requirement.

HB 2678 (2021). Effective November 1, 2021. Scope: all state-regulated health benefit plans (insurers/PBMs subject to OID's Unfair Claims Settlement Practices Act). No generic exception in the text. Reaches: fully-insured, HMO.

Applies to any health insurer or PBM handling pharmacy benefits for a state-regulated health plan, with no generic-drug exception -- the counting requirement is unconditional.

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To the extent permitted by federal law, an insurer offering a health plan that provides pharmacy benefits and a pharmacy benefit manager shall include all amounts paid by an enrollee or paid by another person on behalf of an enrollee toward the cost of a covered prescription drug when calculating the enrollee's contribution to an out-of-pocket maximum, deductible, copayment, coinsurance or other cost-sharing requirement applied to the drug if: (a) The drug does not have a generic equivalent; or (b) The drug has a generic equivalent and the enrollee has obtained prior authorization, complied with a step therapy protocol, or received approval through the exceptions, appeal or review process.

HB 4113 (2024). Scope: individual and group health benefit plans and similar DCBS-regulated arrangements, including HMOs; excludes Medicare, Medicaid, TRICARE, federal-employee plans, workers' comp, limited-benefit coverage, and PEBB/OEBB plans. Generic/biosimilar exception: Does not apply when a generic equivalent exists unless the enrollee obtained the brand-name drug via prior authorization, a step therapy protocol, or the insurer's/PBM's exceptions, appeal, or review process. Reaches: fully-insured, individual, group, HMO.

Conditional, not blanket: counts fully only when the drug has no generic; if a generic exists, third-party payments count only if the enrollee reached the brand via prior authorization, step therapy, or an exceptions/appeal process. The enacted text does not print a fixed effective date -- verify the current compliance date before citing one.

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We checked the state's insurance code and department and found no accumulator provision as of September 20, 2026.

We checked the state's insurance code and department and found no accumulator provision as of September 20, 2026.

We checked the state's insurance code and department and found no accumulator provision as of September 20, 2026.

We checked the state's insurance code and department and found no accumulator provision as of September 20, 2026.

When calculating an enrollee's contribution to an applicable cost sharing requirement, an insurer shall include cost sharing amounts paid by the enrollee or on behalf of the enrollee by another person.

HB 619 (Public Chapter 405) (2021). Effective July 1, 2021. Scope: insurers offering health insurance coverage as defined in § 56-7-109 (fully-insured individual and group health plans). Generic/biosimilar exception: Does not apply to a prescription drug with a generic alternative unless the enrollee obtained the brand-name drug through prior authorization, a step therapy protocol, the insurer's exceptions/appeals process, or as specified in Tenn. Code Ann. § 53-10-204(a). Added by House Amendment #1 before final passage; confirmed via the TN General Assembly's own bill-history/amendments page. Reaches: fully-insured, individual, group.

Does not apply to a drug with a generic alternative unless the enrollee got the brand-name drug via prior authorization, step therapy, or the insurer's exceptions/appeals process.

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An issuer of a health benefit plan that covers prescription drugs or a pharmacy benefit manager shall apply any third-party payment, financial assistance, discount, product voucher, or other reduction in out-of-pocket expenses made by or on behalf of an enrollee for a prescription drug to the enrollee's deductible, copayment, cost-sharing responsibility, or out-of-pocket maximum.

HB 999 (2023). Effective January 1, 2024. Scope: fully-insured individual and group health benefit plans that cover prescription drugs, and PBMs administering them (Tex. Ins. Code Chapter 1369). Generic/biosimilar exception: Applies unconditionally only if the drug (or interchangeable biological product) has no generic equivalent; if a generic equivalent exists, the requirement applies only where the enrollee accessed the brand drug via prior authorization, a step therapy protocol, or the issuer's/PBM's exceptions and appeals process. Reaches: fully-insured, individual, group, HMO, PPO.

Applies to fully-insured plans (not self-funded ERISA plans) delivered, issued, or renewed on or after Jan 1, 2024. Full counting is guaranteed only when there's no generic/interchangeable-biosimilar equivalent; otherwise it depends on how the enrollee accessed the brand drug.

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Not checked against the state's own code this cycle; the trackers we consulted list no law.

We checked the state's insurance code and department and found no accumulator provision as of September 20, 2026.

18 V.S.A. §9472(f)(2) requires amounts 'paid by a covered person' to count toward the deductible; it does not reach manufacturer or other third-party payments, and Vermont's regulator has called the broader reading only 'suggested'. Not an accumulator law.

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To the extent permitted by federal law and regulation and except as provided in subsection D, when calculating an enrollee's overall contribution to any out-of-pocket maximum or any cost-sharing requirement under a health plan, a carrier shall include any amounts paid by the enrollee or paid on behalf of the enrollee by another person.

HB 2515 / SB 1596 (2019 Acts cc. 661, 662) (2019). Effective July 1, 2019. Scope: all health plans subject to Virginia insurance regulation. No generic exception in the text. Reaches: fully-insured, individual, group, HMO, PPO.

'Health plan' excludes Medicare, Medicaid, CHIP, federal-employee coverage, and TRICARE. HSA-qualified high-deductible plans get a timing carve-out (subsection D) — third-party payments need not count toward the deductible until the federal minimum HDHP deductible is met, except for preventive care.

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when calculating an enrollee's contribution to any applicable cost-sharing or out-of-pocket maximum, a health carrier offering a nongrandfathered health plan with a pharmacy benefit, or a health care benefit manager administering benefits for the health carrier, shall include any cost-sharing amounts paid by the enrollee directly or on behalf of the enrollee by another person for a covered prescription drug ... Any cost-sharing amounts paid directly by or on behalf of the enrollee by another person for a covered prescription drug under subsection (1) of this section shall be applied towards the enrollee's applicable cost-sharing or out-of-pocket maximum in full at the time it is rendered.

SSB 5610 (2022 c. 228) (2022). Effective January 1, 2023. Scope: nongrandfathered health plans with a pharmacy benefit issued or renewed on/after 2023-01-01, plus non-Title-48 state employee (PEBB) plans under RCW 41.05. Generic/biosimilar exception: Applies without condition to drugs without a generic equivalent or preferred therapeutic equivalent under the plan's formulary. For a drug WITH a generic/preferred therapeutic equivalent, third-party payments must still count if the enrollee accessed the brand via (i) prior authorization, (ii) step therapy, or (iii) the RCW 48.43.420 exception-request process — including the time between the health care benefit manager's decision and when it communicates that decision to the carrier, if a manager is used for that process. Reaches: fully-insured, individual, group, HMO, state employee/PEBB plans (RCW 41.05).

Codified at RCW 48.43.435; applies to nongrandfathered plans with a pharmacy benefit issued/renewed on/after Jan 1, 2023. Deductible-only carve-out for drugs not themselves subject to a deductible, unless the plan's own terms say otherwise; HSA-qualified plans excluded to the extent needed to preserve tax-exempt status.

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When calculating an insured's contribution to any applicable cost sharing requirement, including, but not limited to, the annual limitation on cost sharing subject to 42 U.S.C. § 18022(c) and 42 U.S.C. § 300gg-6(b): (1) An insurer shall include any cost sharing amounts paid by the insured or on behalf of the insured by another person; and (2) A pharmacy benefits manager shall include any cost sharing amounts paid by the insured or on behalf of the insured by another person.

HB 2770 (2019); later amended by SB 594 (2023), HB 5379 (2024), HB 3092 (2025) (2019). Effective January 1, 2020. Scope: policies, contracts, plans, or agreements delivered, executed, issued, amended, adjusted, or renewed in West Virginia on/after 2020-01-01 — parallel sections cover individual (§33-15-4t), group (§33-16-3ee), and HMO (§33-25A-8t) lines. No generic exception in the text. Reaches: individual, group, HMO.

No generic-drug exception — the counting requirement is unconditional. HSA-qualified plans get a timing carve-out for the deductible only (not preventive care, which counts from dollar one).

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We checked the state's insurance code and department and found no accumulator provision as of September 20, 2026.

No enacted law as of 2026-09-20. The 'Copays Count' bill (AB 173/SB 203) failed to pass in the 2025-2026 session (died 2026-03-23) — watch for reintroduction next session.

We checked the state's insurance code and department and found no accumulator provision as of September 20, 2026.

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