Signed by Governor Gary Herbert

Vote Smart's Synopsis:

Vote to concur with senate amendments and pass a bill that establishes an insulin price cap.

Highlights:

• Requires health plans entered into or renewed on or after January 1, 2021, that provide coverage of insulin for diabetes to (Sec. 1): 

• Cap the required amount to pay for at least one insulin in each therapy category at $30 for a 30-day supply; and 

• Apply the cap regardless of whether or not the insured has met the plan’s deductible. 

• Authorizes health plans to not utilize the price cap under the following circumstances (Sec. 1): 

• The plan covers at least one insulin treatment of diabetes in each therapy category; 

• The plan does not require cost-sharing other than a co-payment before the plan covers insulin; or

• The plan caps the total amount the insured is required to pay for at least one 30-day supply of insulin in each therapy category. 

• Defines a “therapy category” as a type of insulin that is distinct from other types of insulin due to a difference in onset, peak time, or duration (Sec 1). 

• Authorizes health plans that provide cost-sharing coverage for insulin to include the following conditions (Sec. 1): 

• The insured’s participation in wellness activities for individuals with diabetes; 

• Purchasing the insulin at an in-network pharmacy; or

• Choosing insulin from the lowest tier of the health benefit plan. 

• Authorizes the Department of Health to conduct a study on the cost of insulin manufacturing and factors that determine the price of insulin if they receive funds from a  grant (Sec 2). 

• Establishes an Insulin Discount Program that allows participants to purchase insulin at a post-rebate price and pursue a reimbursement from the participant’s health insurer (Sec 3). 

• Authorizes pharmacists to combine refills for an insulin prescription to give a 90-day supply, but may not exceed the total supply authorized by the refills (Sec 4). 

• Authorizes pharmacists to refill insulin for an exhausted prescription one time per expired prescription and for a supply of up to 60 days in an emergency situation (Sec 4). 

• Requires pharmacists who refill exhausted prescriptions in emergency situations to do the following (Sec 4): 

• Attempt to contact the prescribing practitioner and alert them of the expired prescription;

• Notify the prescribing practitioner of the type of insulin prescribed; and 

• Notify the prescribing practitioner of the amount of insulin prescribed.

• Defines “exhausted prescription” as a prescription for insulin that has not expired and has no refills remaining or has not expired six months before the request for a refill (Sec 4).

Full Bill Text