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     Committee Note:
9          The Health and Human Services Interim Committee recommended this bill.
10               Legislative Vote:     12 voting for     0 voting against     6 absent
11     General Description:
12          This bill allows the Public Employees' Benefit and Insurance Program (program) to add
13     additional drugs to the prescription discount program.
14     Highlighted Provisions:
15          This bill:
16          ▸     modifies definitions;
17          ▸     allows the Public Employees' Benefit and Insurance Program to add additional
18     drugs to the prescription discount program;
19          ▸     requires the program to notify the Legislature when an additional drug is added to
20     the program; and
21          ▸     makes technical changes.
22     Money Appropriated in this Bill:
23          None
24     Other Special Clauses:
25          None
26     Utah Code Sections Affected:
27     AMENDS:
28          49-20-421, as last amended by Laws of Utah 2021, Chapter 255
29     

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