Brady Brammer voted Yea (Concurrence Vote) on this Legislation.
Title: Establishes an Insulin Price Cap
Signed by Governor Gary Herbert
Title: Establishes an Insulin Price Cap
Vote to concur with senate amendments and pass a bill that establishes an insulin price cap.
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).
Title: Establishes an Insulin Price Cap
Title: Establishes an Insulin Price Cap
Title: Establishes an Insulin Price Cap