7 LONG TITLE
8 General Description:
9 This bill creates a mechanism to increase Utahns' access to epinephrine auto-injectors.
10 Highlighted Provisions:
11 This bill:
12 ▸ directs the Public Employees' Benefit and Insurance Program to expand the discount
13 program to allow participants to purchase epinephrine auto-injectors at a discounted
14 price; Ĥ→ [
14a ▸ modifies the circumstances under which the Public Employees' Benefit and
14b Insurance Program offers the discount program; and ←Ĥ
15 ▸ permits a health benefit plan that provides coverage for epinephrine auto-injectors
16 to not reimburse a participant who purchased an epinephrine auto-injector through
17 the discount program.
18 Money Appropriated in this Bill:
20 Other Special Clauses:
21 This bill provides a special effective date.
22 Utah Code Sections Affected:
24 49-20-421, as enacted by Laws of Utah 2020, Chapter 310
26 31A-22-656, Utah Code Annotated 1953
28 Be it enacted by the Legislature of the state of Utah:
29 Section 1. Section 31A-22-656 is enacted to read:
30 31A-22-656. Coverage of epinephrine auto-injector.
31 A health benefit plan entered into or renewed on or after July 1, 2021, that provides
32 coverage of an epinephrine auto-injector is not required to reimburse a participant, as that term
33 is defined in Section 49-20-421, for an epinephrine auto-injector the participant obtains
34 through the discount program described in Section 49-20-421.
35 Section 2. Section 49-20-421 is amended to read:
36 49-20-421. Prescription discount program.
37 (1) As used in this section:
38 (a) "Diabetes" means:
39 (i) complete insulin deficiency or type 1 diabetes;
40 (ii) insulin resistant with partial insulin deficiency or type 2 diabetes; or
41 (iii) elevated blood glucose levels induced by pregnancy or gestational diabetes.
42 (b) "Discount program" means a process developed by the program that allows
43 participants to purchase [
44 (c) "Epinephrine auto-injector" means the same as that term is defined in Section
47 diabetes and who uses insulin to treat diabetes.
51 (i) has a qualified condition;
52 (ii) does not receive health coverage under the program; and
53 (iii) enrolls in the discount program.
56 (h) "Qualified condition" means the individual:
57 (i) uses insulin to treat diabetes; or
58 (ii) has a prescription or a standing prescription drug order for an epinephrine
59 auto-injector issued under Section 58-17b-1005.
60 (i) "Qualified prescription" means:
61 (i) insulin; or
62 (ii) epinephrine auto-injector.
64 (2) Notwithstanding Subsection 49-20-201(1), and for the purpose of the [
65 discount program only, the program shall offer [
66 participants to purchase [
66a Ĥ→ when a rebate is available ←Ĥ .
67 (3) The discount program described in Subsection (2) shall:
68 (a) provide a participant with a card or electronic document that identifies the
69 participant as eligible for the discount on a qualified prescription related to the participant's
70 qualified condition;
71 (b) provide a participant with information about pharmacies that will honor the
73 (c) allow a participant to purchase [
74 post-rebate price; and
75 (d) provide a participant with instructions to pursue a reimbursement of the purchase
76 price from the participant's health insurer.
77 (4) The discount program shall charge a price for [
78 allows the program to retain only enough of any rebate for the [
79 to make the state risk pool whole for providing a discounted [
81 Section 3. Effective date.
82 This bill takes effect on July 1, 2021.