Washington State
House of Representatives
Office of Program Research
BILL
ANALYSIS
Health Care & Wellness Committee
SSB 5729
Brief Description: Removing the expiration date on the cost-sharing cap for insulin.
Sponsors: Senate Committee on Health & Long Term Care (originally sponsored by Senators Keiser, Cleveland, Hasegawa, Hunt, Kuderer, Nguyen, Shewmake, Stanford, Valdez and Wilson, C.).
Brief Summary of Substitute Bill
  • Removes the expiration date on the $35 cost-sharing cap for insulin.
Hearing Date: 3/14/23
Staff: Ingrid Lewis (786-7293).
Background:

Insulin is a hormone produced by the pancreas that regulates blood sugar levels.  Many individuals with diabetes require insulin therapy to regulate blood sugar.  The different types of insulin therapies range from rapid- to long-acting and come in various delivery methods:  syringe or pen, pump, and inhaler.

 

In 2020 the Legislature directed health plans, beginning January 1, 2021, to limit an enrollee's out-of-pocket expenses for insulin to an amount not to exceed $100 for a 30-day supply until January 1, 2023.  In 2022 the Legislature amended the statute to further limit an enrollee's out-of-pocket expenses for insulin to an amount not to exceed $35 for a 30-day supply until January 1, 2024.  Prescription insulin drugs must be covered without being subject to a deductible, and any out-of-pocket costs paid by an enrollee must be applied toward the enrollee's deductible obligation.
Summary of Bill:

The expiration date limiting out-of-pocket expenses to $35 for a 30-day supply of insulin is removed.
Appropriation: None.
Fiscal Note: Available.  New fiscal note requested on March 13, 2023.
Effective Date: The bill takes effect 90 days after adjournment of the session in which the bill is passed.