1     
EPINEPHRINE AUTO-INJECTOR ACCESS AMENDMENTS

2     
2021 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Suzanne Harrison

5     
Senate Sponsor: Michael S. Kennedy

6     

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; and
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:
19          None
20     Other Special Clauses:
21          This bill provides a special effective date.
22     Utah Code Sections Affected:
23     AMENDS:
24          49-20-421, as enacted by Laws of Utah 2020, Chapter 310
25     ENACTS:
26          31A-22-656, Utah Code Annotated 1953
27     

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 [insulin] a qualified prescription at a discounted, post-rebate rate.
44          (c) "Epinephrine auto-injector" means the same as that term is defined in Section
45     26-41-102.
46          [(c)] (d) "Individual with diabetes" means an individual who has been diagnosed with
47     diabetes and who uses insulin to treat diabetes.
48          [(d)] (e) "Insulin" means a prescription drug that contains insulin.
49          [(e)] (f) "Participant" means a resident of Utah who:
50          [(i) 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.
54          [(f)] (g) "Prescription drug" means the same as that term is defined in Section
55     58-17b-102.
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.
63          [(g)] (j) "Rebate" means the same as that term is defined in Section 31A-46-102.
64          (2) Notwithstanding Subsection 49-20-201(1), and for the purpose of the [insulin]
65     discount program only, the program shall offer [an insulin] a discount program that allows
66     participants to purchase [insulin] a qualified prescription at a discounted, post-rebate price.
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
72     discount;
73          (c) allow a participant to purchase [insulin] a qualified prescription at a discounted,
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 [insulin] a qualified prescription that
78     allows the program to retain only enough of any rebate for the [insulin] qualified prescription
79     to make the state risk pool whole for providing a discounted [insulin] qualified prescription to
80     participants.
81          Section 3. Effective date.
82          This bill takes effect on July 1, 2021.