HB240:

State health plan; insulin discount program, cost sharing for insulin.

Bill Summary:

State health plan; insulin discount program; health insurance; cost sharing for insulin. Requires the state health plan established by the Department of Human Resource Management to offer an insulin discount program that allows individuals other than state employees to purchase insulin at a discounted, post-rebate price. The bill requires the insulin discount program to (i) allow a participant to purchase insulin at a discounted, post-rebate price; (ii) provide a participant with a card or electronic document that identifies the participant as eligible for the discount; (iii) provide a participant with information about pharmacies that will honor the discount; and (iv) provide a participant with instructions to pursue a reimbursement of the purchase price from the participant's carrier. The bill requires the discount program to charge a price for insulin that allows the program to retain only enough of any rebate for the insulin to make the state risk pool whole for providing discounted insulin to participants.

Additionally, the bill requires health plans offered by a carrier to set the cost-sharing payment that a covered person is required to pay for at least one prescription insulin drug in each therapy category at an amount that does not exceed $30 per 30-day supply of the prescription insulin drug unless the health plan (a) covers at least one prescription insulin drug for the treatment of diabetes in each therapy category under the lowest tier of drugs and does not require cost sharing other than the cost sharing payment before the plan will cover insulin at the lowest tier or (b) guarantees that a covered person is not required to pay more out of pocket for a prescription insulin drug than the covered person would pay to obtain the prescription insulin drug through the insulin discount program and caps the total amount that a covered person is required to pay for at least one prescription insulin drug in each therapy category at an amount not to exceed $100 per 30-day supply of the prescription insulin drug. Under current law, a health plan is required to set the cost-sharing payment that a covered person is required to pay for a covered prescription insulin drug at an amount that does not exceed $50 per 30-day supply of the prescription insulin drug, regardless of the amount or type of insulin needed to fill the covered person's prescription.

The bill also allows a health plan that provides coverage of a prescription insulin drug with the cost-sharing limits established in the bill to condition the cost-sharing limits on (1) the covered person's participation in a wellness-related activities for diabetes, (2) purchasing the prescription insulin drug at an in-network pharmacy, or (3) choosing a prescription insulin drug from the lowest ties of the health plan' s formulary.