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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;
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
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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 [
46 (c) "Epinephrine auto-injector" means the same as that term is defined in Section
47 26-41-102.
48 [
49 diabetes and who uses insulin to treat diabetes.
50 [
51 [
52 [
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 [
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 [
66 (2) Notwithstanding Subsection 49-20-201(1), and for the purpose of the [
67 discount program only, the program shall offer [
68 participants to purchase [
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 [
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 [
81 allows the program to retain only enough of any rebate for the [
82 to make the state risk pool whole for providing a discounted [
83 participants.
84 Section 3. Effective date.
85 This bill takes effect on July 1, 2021.
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