SENATE HEALTH AND PUBLIC AFFAIRS COMMITTEE SUBSTITUTE FOR

SENATE BILL 443

57th legislature - STATE OF NEW MEXICO - first session, 2025

 

 

 

 

 

 

 

AN ACT

RELATING TO INSURANCE; AMENDING THE HEALTH CARE PURCHASING ACT AND SECTIONS OF THE NEW MEXICO INSURANCE CODE TO PROHIBIT COST SHARING FOR MEDICATIONS USED FOR THE TREATMENT OF CHOLESTEROL DISORDER.

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

     SECTION 1. A new section of the Health Care Purchasing Act is enacted to read:

     "[NEW MATERIAL] COVERAGE FOR MEDICATIONS USED FOR THE TREATMENT OF CHOLESTEROL DISORDER.--

          A. Group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act that provides coverage for cholesterol-lowering medications shall not impose cost sharing on those medications.

          B. For the purposes of this section, "cost sharing" means a copayment, coinsurance, a deductible or any other form of financial obligation of an enrollee other than a premium or a share of a premium, or any combination of any of these financial obligations, as defined by the terms of a group health plan.

          C. The provisions of this section do not apply to excepted benefit plans as provided pursuant to the Short-Term Health Plan and Excepted Benefit Act, catastrophic plans as defined pursuant to 42 USCA Section 18022(e) or high deductible health plans with health savings accounts until an eligible insured's deductible has been met, unless otherwise allowed pursuant to federal law."

     SECTION 2. A new section of Chapter 59A, Article 22 NMSA 1978 is enacted to read:

     "[NEW MATERIAL] COVERAGE FOR MEDICATIONS USED FOR THE TREATMENT OF CHOLESTEROL DISORDER.--

          A. 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 that provides coverage for cholesterol-lowering medications shall not impose cost sharing on those medications.

          B. For the purposes of this section, "cost sharing" means a copayment, coinsurance, a deductible or any other form of financial obligation of the insured other than a premium or a share of a premium, or any combination of any of these financial obligations, as defined by the terms of an individual or group health insurance policy, health care plan or certificate of health insurance.

          C. The provisions of this section do not apply to excepted benefit plans as provided pursuant to the Short-Term Health Plan and Excepted Benefit Act, catastrophic plans as defined pursuant to 42 USCA Section 18022(e) or high deductible health plans with health savings accounts until an eligible insured's deductible has been met, unless otherwise allowed pursuant to federal law."

     SECTION 3. A new section of Chapter 59A, Article 23 NMSA is enacted to read:

     "[NEW MATERIAL] COVERAGE FOR MEDICATIONS USED FOR THE TREATMENT OF CHOLESTEROL DISORDER.--

          A. A group or blanket health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state that provides coverage for cholesterol-lowering medications shall not impose cost sharing on those medications.

          B. For the purposes of this section, "cost sharing" means a copayment, coinsurance, a deductible or any other form of financial obligation of a covered person other than a premium or a share of a premium, or any combination of any of these financial obligations, as defined by the terms of a group or blanket health insurance policy, health care plan or certificate of health insurance.

          C. The provisions of this section do not apply to excepted benefit plans as provided pursuant to the Short-Term Health Plan and Excepted Benefit Act, catastrophic plans as defined pursuant to 42 USCA Section 18022(e) or high deductible health plans with health savings accounts until an eligible insured's deductible has been met, unless otherwise allowed pursuant to federal law."

     SECTION 4. A new section of the Health Maintenance Organization Law is enacted to read:

     "[NEW MATERIAL] COVERAGE FOR MEDICATIONS USED FOR THE TREATMENT OF CHOLESTEROL DISORDER.--

          A. An individual or group health maintenance organization contract that is delivered, issued for delivery or renewed in this state that provides coverage for cholesterol-lowering medications shall not impose cost sharing on those medications.

          B. For the purposes of this section, "cost sharing" means a copayment, coinsurance, a deductible or any other form of financial obligation of an enrollee other than a premium or a share of a premium, or any combination of any of these financial obligations, as defined by the terms of an individual or group health maintenance organization contract.

          C. The provisions of this section do not apply to excepted benefit plans as provided pursuant to the Short-Term Health Plan and Excepted Benefit Act, catastrophic plans as defined pursuant to 42 USCA Section 18022(e) or high deductible health plans with health savings accounts until an eligible insured's deductible has been met, unless otherwise allowed pursuant to federal law."

     SECTION 5. A new section of the Nonprofit Health Care Plan Law is enacted to read:

     "[NEW MATERIAL] COVERAGE FOR MEDICATIONS USED FOR THE TREATMENT OF CHOLESTEROL DISORDER.--

          A. An individual or group health care plan that is delivered, issued for delivery or renewed in this state that provides coverage for cholesterol-lowering medications shall not impose cost sharing on those medications.

          B. For the purposes of this section, "cost sharing" means a copayment, coinsurance, a deductible or any other form of financial obligation of a subscriber other than a premium or a share of a premium, or any combination of any of these financial obligations, as defined by the terms of an individual or group health care plan.

          C. The provisions of this section do not apply to excepted benefit plans as provided pursuant to the Short-Term Health Plan and Excepted Benefit Act, catastrophic plans as defined pursuant to 42 USCA Section 18022(e) or high deductible health plans with health savings accounts until an eligible insured's deductible has been met, unless otherwise allowed pursuant to federal law."

     SECTION 6. EFFECTIVE DATE.--The effective date of the provisions of this act is January 1, 2026.

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