SENATE BILL REPORT
SB 5776
As of January 4, 2024
Title: An act relating to accessing an emergency supply of insulin.
Brief Description: Accessing an emergency supply of insulin.
Sponsors: Senators Keiser, Cleveland, Randall, Van De Wege, Conway, Dhingra and Kauffman.
Brief History:
Committee Activity: Health & Long Term Care: 1/11/24.
Brief Summary of Bill
  • Creates a program for eligible individuals to receive one emergency 30-day supply of insulin within a 12-month period for a maximum cost sharing amount of $10.
SENATE COMMITTEE ON HEALTH & LONG TERM CARE
Staff: Greg Attanasio (786-7410)
Background:

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 until January 1, 2023. In 2022, the Legislature amended the statute to reduce the limit on out-of-pocket expenses for a 30-day supply of insulin to $35 until January 1, 2024, and in 2023 the Legislature removed the expiration date for the $35 limit. Also in 2023, the federal government limited out-of-pocket expenses for a 30-day supply of insulin to $35 for Medicare enrollees.
Summary of Bill:

Beginning in 2025, individuals who meet the eligibility requirements may receive one emergency 30-day supply of insulin within a 12-month period with a maximum cost-sharing amount of $10. To be eligible, and individual must:

  • be a resident of Washington;
  • not be enrolled in Medicaid;
  • not be enrolled in prescription drug coverage that limits out-of-pocket expenses for a 30-day supply of insulin to $35 or less;
  • have a valid prescription for insulin; and
  • have less than a seven day supply.

 

The Health Care Authority (HCA) must develop an application for individuals to demonstrate their eligibility and make that application available to pharmacies and providers. Upon receipt of a completed application, a pharmacy must dispense the insulin. The pharmacy may collect a fee of up to $10 to cover the pharmacy's cost of processing and dispensing the insulin.

 

Each manufacturer of insulin sold in Washington must develop a process for a pharmacy to submit an electronic claim for reimbursement for the dispensed insulin. After a pharmacy submits the claim, a manufacturer, within 30 days, must reimburse the pharmacy or send the pharmacy a replacement supply of the same insulin dispensed by the pharmacy.

 

HCA may assess a fine of up to $10,000 for each failure of a manufacturer to comply with the reimbursement requirements of this act.
Appropriation: None.
Fiscal Note: Requested on January 3, 2024.
Creates Committee/Commission/Task Force that includes Legislative members: No.
Effective Date: The bill takes effect on January 1, 2025.