Chief Sponsor: Suzanne Harrison

Senate Sponsor: Michael S. Kennedy


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;
15          ▸     modifies the circumstances under which the Public Employees' Benefit and
16     Insurance Program offers the discount program; and
17          ▸     permits a health benefit plan that provides coverage for epinephrine auto-injectors
18     to not reimburse a participant who purchased an epinephrine auto-injector through
19     the discount program.
20     Money Appropriated in this Bill:
21          None
22     Other Special Clauses:
23          This bill provides a special effective date.
24     Utah Code Sections Affected:
25     AMENDS:
26          49-20-421, as enacted by Laws of Utah 2020, Chapter 310
27     ENACTS:
28          31A-22-656, Utah Code Annotated 1953

30     Be it enacted by the Legislature of the state of Utah:
31          Section 1. Section 31A-22-656 is enacted to read:
32          31A-22-656. Coverage of epinephrine auto-injector.
33          A health benefit plan entered into or renewed on or after July 1, 2021, that provides
34     coverage of an epinephrine auto-injector is not required to reimburse a participant, as that term
35     is defined in Section 49-20-421, for an epinephrine auto-injector the participant obtains
36     through the discount program described in Section 49-20-421.
37          Section 2. Section 49-20-421 is amended to read:
38          49-20-421. Prescription discount program.
39          (1) As used in this section:
40          (a) "Diabetes" means:
41          (i) complete insulin deficiency or type 1 diabetes;
42          (ii) insulin resistant with partial insulin deficiency or type 2 diabetes; or
43          (iii) elevated blood glucose levels induced by pregnancy or gestational diabetes.
44          (b) "Discount program" means a process developed by the program that allows
45     participants to purchase [insulin] a qualified prescription at a discounted, post-rebate rate.
46          (c) "Epinephrine auto-injector" means the same as that term is defined in Section
47     26-41-102.
48          [(c)] (d) "Individual with diabetes" means an individual who has been diagnosed with
49     diabetes and who uses insulin to treat diabetes.
50          [(d)] (e) "Insulin" means a prescription drug that contains insulin.
51          [(e)] (f) "Participant" means a resident of Utah who:
52          [(i) uses insulin to treat diabetes;]
53          (i) has a qualified condition;
54          (ii) does not receive health coverage under the program; and
55          (iii) enrolls in the discount program.
56          [(f)] (g) "Prescription drug" means the same as that term is defined in Section
57     58-17b-102.

58          (h) "Qualified condition" means the individual:
59          (i) uses insulin to treat diabetes; or
60          (ii) has a prescription or a standing prescription drug order for an epinephrine
61     auto-injector issued under Section 58-17b-1005.
62          (i) "Qualified prescription" means:
63          (i) insulin; or
64          (ii) epinephrine auto-injector.
65          [(g)] (j) "Rebate" means the same as that term is defined in Section 31A-46-102.
66          (2) Notwithstanding Subsection 49-20-201(1), and for the purpose of the [insulin]
67     discount program only, the program shall offer [an insulin] a discount program that allows
68     participants to purchase [insulin] a qualified prescription at a discounted, post-rebate price
69     when a rebate is available.
70          (3) The discount program described in Subsection (2) shall:
71          (a) provide a participant with a card or electronic document that identifies the
72     participant as eligible for the discount on a qualified prescription related to the participant's
73     qualified condition;
74          (b) provide a participant with information about pharmacies that will honor the
75     discount;
76          (c) allow a participant to purchase [insulin] a qualified prescription at a discounted,
77     post-rebate price; and
78          (d) provide a participant with instructions to pursue a reimbursement of the purchase
79     price from the participant's health insurer.
80          (4) The discount program shall charge a price for [insulin] a qualified prescription that
81     allows the program to retain only enough of any rebate for the [insulin] qualified prescription
82     to make the state risk pool whole for providing a discounted [insulin] qualified prescription to
83     participants.
84          Section 3. Effective date.
85          This bill takes effect on July 1, 2021.