1     
PRESCRIPTION DISCOUNT PROGRAM AMENDMENTS

2     
2023 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Raymond P. Ward

5     
Senate Sponsor: Michael S. Kennedy

6     

7     LONG TITLE
8     General Description:
9          This bill allows the Public Employees' Benefit and Insurance Program (program) to add
10     additional drugs to the prescription discount program.
11     Highlighted Provisions:
12          This bill:
13          ▸     modifies definitions;
14          ▸     allows the Public Employees' Benefit and Insurance Program to add additional
15     drugs to the prescription discount program;
16          ▸     requires the program to notify the Legislature when an additional drug is added to
17     the program; and
18          ▸     makes technical changes.
19     Money Appropriated in this Bill:
20          None
21     Other Special Clauses:
22          None
23     Utah Code Sections Affected:
24     AMENDS:
25          49-20-421, as last amended by Laws of Utah 2021, Chapter 255
26     

27     Be it enacted by the Legislature of the state of Utah:
28          Section 1. Section 49-20-421 is amended to read:
29          49-20-421. Prescription discount program.
30          (1) As used in this section:
31          [(a) "Diabetes" means:]
32          [(i) complete insulin deficiency or type 1 diabetes;]
33          [(ii) insulin resistant with partial insulin deficiency or type 2 diabetes; or]
34          [(iii) elevated blood glucose levels induced by pregnancy or gestational diabetes.]
35          [(b)] (a) "Discount program" means [a process developed by the program that allows
36     participants to purchase a qualified prescription at a discounted, post-rebate rate] the
37     prescription discount program created by this section.
38          [(c)] (b) "Epinephrine auto-injector" means the same as that term is defined in Section
39     26-41-102.
40          [(d) "Individual with diabetes" means an individual who has been diagnosed with
41     diabetes and who uses insulin to treat diabetes.]
42          [(e)] (c) "Insulin" means a prescription drug that contains insulin.
43          [(f)] (d) "Participant" means a resident of Utah who:
44          (i) [has a qualified condition] has a prescription or standing prescription for a qualified
45     prescription;
46          (ii) does not receive health coverage under the program; and
47          (iii) enrolls in the discount program.
48          [(g)] (e) "Prescription drug" means the same as that term is defined in Section
49     58-17b-102.
50          [(h) "Qualified condition" means the individual:]
51          [(i) uses insulin to treat diabetes; or]
52          [(ii) has a prescription or a standing prescription drug order for an epinephrine
53     auto-injector issued under Section 58-17b-1005.]
54          [(i) "Qualified prescription" means:]
55          [(i) insulin; or]
56          [(ii) epinephrine auto-injector.]
57          (f) "Qualified prescription" means a prescription drug, including insulin and
58     epinephrine auto-injectors, that the program has determined:
59          (i) treats a serious, prevalent, and ongoing condition;
60          (ii) does not have a generic substitute;
61          (iii) qualifies for a substantial rebate; and
62          (iv) would not result in financial losses to the state risk pool if sold as part of the
63     discount program.
64          [(j)] (g) "Rebate" means the same as that term is defined in Section 31A-46-102.
65          (2) [Notwithstanding Subsection 49-20-201(1), and for the purpose of the discount
66     program only, the program shall offer a discount program that allows participants to purchase a
67     qualified prescription at a discounted, post-rebate price when a rebate is available.] The
68     program shall create a prescription discount program for a participant to purchase a qualified
69     prescription at a discounted, post-rebate price.
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; and
76          [(c) allow a participant to purchase a qualified prescription at a discounted, post-rebate
77     price; and]
78          [(d)] (c) provide a participant with instructions to pursue a reimbursement of the
79     purchase price from the participant's health insurer.
80          [(4) The discount program shall charge a price for a qualified prescription that allows
81     the program to retain only enough of any rebate for the qualified prescription to make the state
82     risk pool whole for providing a discounted qualified prescription to participants.]
83          (4) The program may not retain any amount of a rebate for a qualified prescription
84     except for an amount necessary to make the state risk pool whole for providing the qualified
85     prescription to participants.
86          (5) For each drug added to the discount program, the program shall notify the Health
87     and Human Services Interim Committee, providing:
88          (a) the name of the drug; and
89          (b) the primary condition the drug treats.