In 2020, the Legislature directed health plans, beginning January 1, 2021, to limit an enrollee's out-of-pocket expenses for insulin to $100 for a 30-day supply. The out-of-pocket limit is set to expire on January 1, 2023.
Beginning January 1, 2023, health plans must cap the total amount an enrollee is required to pay for a covered insulin drug at an amount not to exceed $35 per 30-day supply. This limit expires on January 1, 2024.
Removes changes to the total cost of insulin work group.
The committee recommended a different version of the bill than what was heard. PRO: Insulin needs to remain affordable for those who need it. Emergency access to insulin is an important component of the bill and can be the difference between life and death. Copays are not the only expense for a person with diabetes and other related medical expenses are also expensive. The copay cap would align with Medicare Part D.
OTHER: Health plans are not opposed to extending cap but are concerned about lowering the amount. Health plans are not opposed to re-balancing the work group membership.