Ever wonder about the actual difference between a pharmacy benefit and a medical benefit? This explainer cuts through the health insurance jargon to break down cost-sharing protections and drug benefit practices in clear, simple terms.
This resource discusses deductibles and their interaction with other forms of cost sharing, as well as estimates regarding their presence among state-regulated health insurance, potential impacts of new prohibitions on their application, and related state and federal law.
Resource
Cost Sharing
Health Insurance Coverage
Deductibles in State-Regulated Health Insurance for 2026
This issue brief discusses laws and regulations that prohibit out-of-network (OON) providers from issuing surprise bills to enrollees in plans or policies regulated by DMHC or CDI.
Issue Brief
Cost Sharing
State and Federal Law
Balance Billing Prohibitions and the No Surprises Act
This issue brief discusses cost sharing laws and limits that are applicable to outpatient prescription drug benefits regulated by the Department of Managed Health Care (DMHC) and the California Department of Insurance (CDI). This brief also discusses pharmacy benefits, cost sharing, and the laws that are relevant to them.
