FINAL BILL REPORT

E2SSB 6087

C 245 L 20

Synopsis as Enacted

Brief Description: Imposing cost-sharing requirements for coverage of insulin products.

Sponsors: Senate Committee on Ways & Means (originally sponsored by Senators Keiser, Conway, Das, Hasegawa, Hunt, Kuderer, Pedersen, Randall, Rolfes, Stanford, Saldaña, Wilson, C. and Sheldon).

Senate Committee on Health & Long Term Care

Senate Committee on Ways & Means

House Committee on Health Care & Wellness

Background: According to data from the All Payer Claims Database (APCD), in 2018, approximately 90,000 Washington residents filled 771,000 prescriptions for insulin, which represents a 15 percent increase since 2014. This number does not include Veteran's Administration plans and some self-insured plans not captured by the APCD.

Out-of-pocket expenses for Washington enrollees of Medicaid, Medicare, and commercial plans totaled $31 million in 2018. Out-of-pocket expenses vary by payer, with Medicare enrollees paying the most and Medicaid enrollees paying little to nothing. Out-of-pocket expenses in the commercial market vary by plan type and design. Health Care Authority (HCA) data indicates that for Public Employees' Benefits Board enrollees covered under the Uniform Medical Plan, those enrolled in the Classic or Plus plans pay approximately $35 per month, while those enrolled in the consumer driven health plan pay an average of $206 per month.

Summary: Health plans issued or renewed on or after January 1, 2021, must cap out-of-pocket expenses for a 30-day supply of insulin at $100. This requirement would apply to high deductible plans with health savings accounts, but if the Internal Revenue Service removes insulin from the list of preventative care services, then a health plan must set the out-of-pocket amount at the lowest amount allowable.

HCA must monitor the price of insulin.

The requirements in this bill expire on January 1, 2023.

Votes on Final Passage: