1     
PRESCRIPTION COPAYMENT CAP AMENDMENTS

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2020 GENERAL SESSION

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STATE OF UTAH

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Chief Sponsor: Marie H. Poulson

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Senate Sponsor: ____________

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7     LONG TITLE
8     General Description:
9          This bill enacts provisions related to the price of insulin.
10     Highlighted Provisions:
11          This bill:
12          ▸     places a cap on the copayment an insurance company can require for an insulin
13     prescription.
14     Money Appropriated in this Bill:
15          None
16     Other Special Clauses:
17          None
18     Utah Code Sections Affected:
19     AMENDS:
20          31A-22-626, as last amended by Laws of Utah 2015, Chapter 258
21     

22     Be it enacted by the Legislature of the state of Utah:
23          Section 1. Section 31A-22-626 is amended to read:
24          31A-22-626. Coverage of diabetes.
25          (1) As used in this section[, "diabetes"]:
26          (a) "Diabetes" includes individuals with:
27          [(a)] (i) complete insulin deficiency or type 1 diabetes;
28          [(b)] (ii) insulin resistant with partial insulin deficiency or type 2 diabetes; and
29          [(c)] (iii) elevated blood glucose levels induced by pregnancy or gestational diabetes.
30          (b) "Insulin" means a prescription drug that contains insulin.
31          (2) The commissioner shall establish, by rule, minimum standards of coverage for
32     diabetes for accident and health insurance policies that provide a health insurance benefit
33     before July 1, 2000.
34          (3) In making rules under Subsection (2), the commissioner shall require rules:
35          (a) with durational limits, amount limits, deductibles, and coinsurance for the treatment
36     of diabetes equitable or identical to coverage provided for the treatment of other illnesses or
37     diseases; and
38          (b) that provide coverage for:
39          (i) diabetes self-management training and patient management, including medical
40     nutrition therapy as defined by rule, provided by an accredited or certified program and referred
41     by an attending physician within the plan and consistent with the health plan provisions for
42     self-management education:
43          (A) recognized by the federal Centers for Medicare and Medicaid Services; or
44          (B) certified by the Department of Health; and
45          (ii) the following equipment, supplies, and appliances to treat diabetes when medically
46     necessary:
47          (A) blood glucose monitors, including those for the legally blind;
48          (B) test strips for blood glucose monitors;
49          (C) visual reading urine and ketone strips;
50          (D) lancets and lancet devices;
51          (E) insulin;
52          (F) injection aides, including those adaptable to meet the needs of the legally blind, and
53     infusion delivery systems;
54          (G) syringes;
55          (H) prescriptive oral agents for controlling blood glucose levels; and
56          (I) glucagon kits.
57          (4) Beginning January 1, 2021, a health benefit plan that provides coverage for insulin
58     shall cap the total amount that an insured is required to pay for insulin at an amount not to
59     exceed $100 per 30-day supply of insulin, regardless of the amount or type of insulin needed to
60     fill the insured's prescription.