Relating to prescription refills in emergency situations and insurance coverage for prescription insulin

This bill relates to prescription refills in emergency situations and insurance coverage for prescription insulin drugs. The bill allows a pharmacist to exercise professional judgment and refill a prescription once in a 12-month period and to dispense an amount not to exceed a 30-day supply, or if the standard amount of dispensing exceeds a 30-day supply or is unit dosed, an amount not to exceed the standard supply or limit of dispensing. The bill requires a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses that provides coverage for prescription drugs to cap the total amount of cost-sharing that a covered person is required to pay per prescription filled to an amount not to exceed $25 for up to a 31-day supply of at least one type of each of rapid-acting prescription insulin drugs, short-acting prescription insulin drugs, intermediate-acting prescription insulin drugs, or long-acting prescription insulin drugs. “Prescription insulin drug” is defined in the bill as a prescription drug that contains insulin, is used to treat diabetes, has been prescribed as medically necessary by a covered person’s health care professional, and is a benefit covered by a covered person’s policy, contract, or plan. The bill defines “cost-sharing” as any coverage limit, copayment, coinsurance, deductible, or other out-of-pocket expense imposed on a covered person. A policy, contract, or plan is not prohibited from providing for third-party payment or prepayment of health or medical expenses from reducing a covered person’s cost-sharing to less than $25 for a 31-day supply of a prescription insulin drug. This section of the bill applies to third-party payment provider contracts, policies, or plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2023, by the third-party payment providers enumerated in the bill. The types of specialized health-related insurance which are not subject to the coverage requirements are specified in the bill. The commissioner of insurance may adopt rules to administer the requirements of this section of the bill.