Relating to insurance coverage for prescription insulin drugs, and including applicability provisions

This bill relates to prescription insulin drugs and coverage by policies, contracts, or plans providing for third-party payment or prepayment of health or medical expenses that provide coverage for prescription drugs. 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 $100 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. The bill does not prohibit a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses from reducing a covered person’s cost-sharing to less than $100 for a 31-day supply of a prescription insulin drug. 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, 2022, by the third-party payment providers enumerated in the bill. The bill specifies the types of specialized health-related insurance which are not subject to the coverage requirements of the bill. The commissioner of insurance may adopt rules to administer the requirements of the bill.