Signed by Governor Jim Justice, Jr.

Vote Smart's Synopsis:

Vote to pass a bill that establishes a $25 insulin price cap.

Highlights:

• Requires an insurer who issues or renews a health insurance policy on or after July 1, 2020, to provide coverage for prescription insulin (Article 53, Sec. 1).

• Prohibits the cost of a 30-day supply of covered prescription insulin from exceeding $25, regardless of the quality or type of prescription insulin used (Article 53, Sec. 1).

• Requires each health plan to cover at least one type of insulin in all of the following categories (Article 53, Sec. 1):

• Rapid-acting; 

• Short-acting; 

• Intermediate-acting; 

• Long-acting; 

• Pre-mixed insulin products; and

• Concentrated human regular insulin. 

• Requires an insurer to provide coverage for the following equipment and supplies for the treatment and management of diabetes for both persons with diabetes (Article 53, Sec. 1):

• Blood glucose monitors; 

• Monitor supplies; 

• Insulin; 

• Injection aids; 

• Syringes; 

• Insulin infusion devices; and

• Pharmacological agents for controlling blood sugar and orthotics. 

• Prohibits any contract between an insurer or its benefits manager and a pharmacy or its contracting agent containing the following provisions (Article 53, Sec. 1):

• Authorizing the insurer’s pharmacy benefit officer or pharmacy to charge an amount that exceeds the cost-sharing payment established in this bill; 

• Requiring the pharmacy to collect any amount that exceeds the cost-sharing payment established in this bill; or

• Requiring a covered person to make a cost-sharing payment for covered prescription insulin in an amount that exceeds the cost-sharing payment established in this bill.

Full Bill Text