Vote Smart's Synopsis:

Vote to pass a bill that limits the out of pocket cost for an insulin prescription at $100.

Highlights:

• Defines “cost-sharing” means any coverage limit, copayment, coinsurance, deductible, or other out-of-pocket expense obligation imposed on a covered person by a policy, contract, or plan to provide for third-party payment or prepayment of health or medical expenses (Sec. 1-1.a).

• Defines “prescription insulin drug” as a prescription drug that contains insulin, is used to treat diabetes, that has been prescribed as medically necessary by a covered person’s healthcare professional, and is a benefit covered by the covered person’s policy, contract, or plan (Sec. 1-1.d).

• Requires a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses that provides coverage for prescription drugs shall cap the total amount of cost-sharing that a covered person is required to pay per prescription filled to an amount not to exceed one hundred dollars for up to a thirty-one-day supply of at least one type of each of the following (Sec. 1-2):

• Rapid-acting prescription insulin drugs.

• Short-acting prescription insulin drugs.

• Intermediate-acting prescription insulin drugs.

• Long-acting prescription insulin drugs.

• Specifies the following classes of third-party payment provider contracts, policies, or plans apply (Sec. 1-4.a):

• Individual or group accident and sickness insurance providing coverage on an expense-incurred basis;

• An individual or group hospital or medical service contract;

• An individual or group health maintenance organization contract;

• A plan established for public employees

• Prohibits this law from applying to accident-only, specified disease, short-term hospital or medical, hospital confinement indemnity, credit, dental, vision, Medicare supplement, long-term care, basic hospital and medical-surgical expense coverage as defined by the commissioner of insurance, disability income insurance coverage, coverage issued as a supplement to liability insurance, workers’ compensation or similar insurance, or automobile medical payment insurance (Sec. 1-4.b).

• Authorizes the commissioner of insurance to adopt rules to administer the requirements of the bill (Sec. 1-5).

• Specifies the types of specialized health-related insurance which are not subject to the coverage requirements of the bill (Sec. 2).

Full Bill Text