{"data":{"id":"us-dc/d.c.-code-48-855.02b","jurisdiction":"us-dc","citation":"D.C. Code § 48-855.02b","heading":"Calculation of member's contributions for a prescription drug covered under the health benefit plan.","body":"(a)\nExcept 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:\n(1)\nIs without a generic drug equivalent or an interchangeable biological product preferred under the health benefit plan's formulary; or\n(2)\nHas 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.\n\n(b)\nSubsection (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).\n\n(c)\nThis section shall apply to health benefit plans entered into, amended, extended, or renewed on or after January 1, 2025.","path":["Title 48. Foods and Drugs.","Chapter 8H. Specialty Drug Copayment Limitation."],"source_url":"https://code.dccouncil.gov/us/dc/council/code/sections/48-855.02b","current_through":"2026-08-20 (D.C. Law 26-175)","vintage":"","retrieved_at":"2026-08-29T05:44:07Z","sha256":"5c2f182c73d631ef82498655fece880530f19a809c4694d214a555547c3f5ec8","source_id":"us-dc","stale":false,"prev":"us-dc/d.c.-code-48-855.02a","next":"us-dc/d.c.-code-48-855.03"},"notice":"GroundRules: Original legal text. Not legal advice."}