California 2021-2022 Regular Session

California Senate Bill SB473 Compare Versions

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1-Amended IN Assembly June 16, 2022 Amended IN Senate January 13, 2022 Amended IN Senate January 03, 2022 Amended IN Senate March 10, 2021 CALIFORNIA LEGISLATURE 20212022 REGULAR SESSION Senate Bill No. 473Introduced by Senator Bates(Coauthor: Senator Rubio)February 17, 2021An act to amend Section 1367.51 of the Health and Safety Code, and to amend Section 10176.61 of the Insurance Code, relating to health care coverage.LEGISLATIVE COUNSEL'S DIGESTSB 473, as amended, Bates. Health care coverage: insulin cost sharing.Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the acts requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan contract or health insurance policy issued, amended, delivered, or renewed on or after January 1, 2000, to include coverage for equipment, supplies, and, if the contract or policy covers prescription benefits, prescriptive medications for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes, as medically necessary.This bill would prohibit require a health care service plan contract or a health insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2023, from imposing cost sharing on a covered insulin prescription, except to cover all available dosage forms and concentrations of at least one insulin product of each insulin type for a copayment not to exceed $35 per month per each dosage form of insulin products. for a monthly supply, or a multiple of $35 for a multimonth supply, and would prohibit a policy or contract from imposing other cost-sharing requirements. The bill would also prohibit a health care service plan contract or health insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2023, from imposing a deductible requirement on benefits related to managing and treating diabetes, as specified. Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that no reimbursement is required by this act for a specified reason.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES Bill TextThe people of the State of California do enact as follows:SECTION 1. The Legislature finds and declares that:(a) Approximately 263,000 Californians are diagnosed with type 1 diabetes each year. Approximately 4,037,000 Californian adults have diabetes.(b) Every Californian with type 1 diabetes, and many with type 2 diabetes, rely on daily doses of insulin to survive.(c) Insulin prices have nearly tripled, creating financial hardships for people who rely on it to survive.(d) One in four people using insulin have reported insulin underuse due to the high cost of insulin.(e) Diabetes is the seventh leading cause of death and a leading cause of disabling and life-threatening complications, including heart disease, stroke, kidney failure, amputation of the lower extremities, and new cases of blindness among adults.(f) Studies have shown that managing diabetes can prevent the complications associated with diabetes.(g) Therefore, it is important to enact policies to reduce the costs for Californians with diabetes to obtain life-saving and life-sustaining insulin.SEC. 2. Section 1367.51 of the Health and Safety Code is amended to read:1367.51. (a) A health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2000, shall include coverage for the following equipment and supplies for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes as medically necessary, even if the items are available without a prescription:(1) Blood glucose monitors and blood glucose testing strips.(2) Blood glucose monitors designed to assist the visually impaired.(3) Insulin pumps and all related necessary supplies.(4) Ketone urine testing strips.(5) Lancets and lancet puncture devices.(6) Pen delivery systems for the administration of insulin.(7) Podiatric devices to prevent or treat diabetes-related complications.(8) Insulin syringes.(9) Visual aids, excluding eyewear, to assist the visually impaired with proper dosing of insulin.(b) A health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2000, that covers prescription drug benefits shall include coverage for the following prescription items if the items are determined to be medically necessary:(1) Insulin.(2) Prescriptive medications for the treatment of diabetes.(3) Glucagon.(c) The copayments and deductibles for the benefits specified in subdivisions (a) and (b) shall not exceed those established for similar benefits within the given plan.(d) (1) Notwithstanding subdivision (c), for a health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, the copayment for an insulin prescription covered pursuant to subdivision (b) shall not exceed thirty-five dollars ($35) per month per each dosage form of insulin products. shall cover all available dosage forms and concentrations of at least one insulin product of each insulin type for a copayment of no more than thirty-five dollars ($35) for a monthly supply. If a contract covers prescription drugs in larger amounts than a monthly supply, the copayment on that amount shall be equal to or less than the multiple of the monthly supply copayment, so that the respective copayment for a 60-day or 90-day supply shall not exceed seventy dollars ($70) or one hundred five dollars ($105).(2) A health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible, coinsurance, or other cost-sharing requirement on an insulin prescription, prescription covered pursuant to paragraph (1), except for a copayment subject to the limitations in paragraph (1).(3)Paragraphs (1) and (2) shall only apply to one of each dosage form and insulin type.(3) For purposes of this subdivision:(A) Dosage form means the form in which insulin is packaged, including vial and pen delivery device.(B) Insulin type means rapid-acting, short-acting, intermediate-acting, or long-acting insulin.(4)(e) A health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible requirement on a benefit described in subdivision (a). If a health care service plan contract is a high deductible health plan, as defined in Section 223(c)(2) of Title 26 of the United States Code, the contract shall not impose a deductible requirement on a benefit described in paragraph (1) or (2) of subdivision (a), or any other benefit described in subdivision (a) for which the Internal Revenue Service has indicated that the minimum deductible may be waived in a high deductible health plan.(e)(f) A health care service plan shall provide coverage for diabetes outpatient self-management training, education, and medical nutrition therapy necessary to enable an enrollee to properly use the equipment, supplies, and medications set forth in subdivisions (a) and (b), and additional diabetes outpatient self-management training, education, and medical nutrition therapy upon the direction or prescription of those services by the enrollees participating physician. If a plan delegates outpatient self-management training to contracting providers, the plan shall require contracting providers to ensure that diabetes outpatient self-management training, education, and medical nutrition therapy are provided by appropriately licensed or registered health care professionals.(f)(g) The diabetes outpatient self-management training, education, and medical nutrition therapy services identified in subdivision (e) (f) shall be provided by appropriately licensed or registered health care professionals as prescribed by a participating health care professional legally authorized to prescribe the service. These benefits shall include, but not be limited to, instruction that will enable diabetic patients and their families to gain an understanding of the diabetic disease process, and the daily management of diabetic therapy, in order to thereby avoid frequent hospitalizations and complications.(g)(h) The copayments for the benefits specified in subdivision (e) (f) shall not exceed those established for physician office visits by the plan.(h)(i) A health care service plan governed by this section shall disclose the benefits covered pursuant to this section in the plans evidence of coverage and disclosure contract forms.(i)(j) A health care service plan shall not reduce or eliminate coverage as a result of this section.(j)(k) This section does not deny or restrict the departments authority to ensure plan compliance with this chapter if a plan provides coverage for prescription drugs.SEC. 3. Section 10176.61 of the Insurance Code is amended to read:10176.61. (a) A health insurance policy issued, amended, or renewed on or after January 1, 2000, shall include coverage for the following equipment and supplies for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes as medically necessary, even if the items are available without a prescription:(1) Blood glucose monitors and blood glucose testing strips.(2) Blood glucose monitors designed to assist the visually impaired.(3) Insulin pumps and all related necessary supplies.(4) Ketone urine testing strips.(5) Lancets and lancet puncture devices.(6) Pen delivery systems for the administration of insulin.(7) Podiatric devices to prevent or treat diabetes-related complications.(8) Insulin syringes.(9) Visual aids, excluding eyewear, to assist the visually impaired with proper dosing of insulin.(b) A health insurance policy that is issued, amended, or renewed on or after January 1, 2000, that covers prescription drug benefits shall include coverage for the following prescription items if the items are determined to be medically necessary:(1) Insulin.(2) Prescriptive medications for the treatment of diabetes.(3) Glucagon.(c) The coinsurances and deductibles for the benefits specified in subdivisions (a) and (b) shall not exceed those established for similar benefits within the given policy.(d) (1) Notwithstanding subdivision (c), for a health insurance policy that is issued, amended, or renewed on or after January 1, 2023, the copayment for an insulin prescription covered pursuant to subdivision (b) shall not exceed thirty-five dollars ($35) per month per each dosage form of insulin products. shall cover all available dosage forms and concentrations of at least one insulin product of each insulin type for a copayment of no more than thirty-five dollars ($35) for a monthly supply. If a policy covers prescription drugs in larger amounts than a monthly supply, the copayment on that amount shall be equal to or less than the multiple of the monthly supply copayment, so that the respective copayment for a 60-day or 90-day supply shall not exceed seventy dollars ($70) or one hundred five dollars ($105).(2) A health insurance policy that is issued, amended, or renewed on or after January 1, 2023, shall not impose a deductible, coinsurance, or other cost-sharing requirement on an insulin prescription, prescription covered pursuant to paragraph (1), except for a copayment subject to the limitations in paragraph (1).(3)Paragraphs (1) and (2) shall only apply to one of each dosage form and insulin type.(3) For purposes of this subdivision:(A) Dosage form means the form in which insulin is packaged, including vial and pen delivery device.(B) Insulin type means rapid-acting, short-acting, intermediate-acting, or long-acting insulin.(4)(e) A health insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible requirement on a benefit described in subdivision (a). If a health insurance policy is a high deductible health plan, as defined in Section 223(c)(2) of Title 26 of the United States Code, the policy shall not impose a deductible requirement on a benefit described in paragraph (1) or (2) of subdivision (a), or any other benefit described in subdivision (a) for which the Internal Revenue Service has indicated that the minimum deductible may be waived in a high deductible health plan.(e)(f) A health insurer shall provide coverage for diabetes outpatient self-management training, education, and medical nutrition therapy necessary to enable an insured to properly use the equipment, supplies, and medications set forth in subdivisions (a) and (b) and additional diabetes outpatient self-management training, education, and medical nutrition therapy upon the direction or prescription of those services by the insureds participating physician. If an insurer delegates outpatient self-management training to contracting providers, the insurer shall require contracting providers to ensure that diabetes outpatient self-management training, education, and medical nutrition therapy are provided by appropriately licensed or registered health care professionals.(f)(g) The diabetes outpatient self-management training, education, and medical nutrition therapy services identified in subdivision (e) (f) shall be provided by appropriately licensed or registered health care professionals as prescribed by a health care professional legally authorized to prescribe the services.(g)(h) The coinsurances and deductibles for the benefits specified in subdivision (e) (f) shall not exceed those established for physician office visits by the insurer.(h)(i) A health insurer governed by this section shall disclose the benefits covered pursuant to this section in the insurers evidence of coverage and disclosure policy forms.(i)(j) A health insurer shall not reduce or eliminate coverage as a result of this section.(j)(k) This section does not apply to vision-only, dental-only, accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, or disability income insurance, except that for accident-only, specified disease, and hospital indemnity insurance coverage, benefits under this section only apply to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy. This section does not impose a new benefit mandate on accident-only, specified disease, or hospital indemnity insurance.SEC. 4. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
1+Amended IN Senate January 13, 2022 Amended IN Senate January 03, 2022 Amended IN Senate March 10, 2021 CALIFORNIA LEGISLATURE 20212022 REGULAR SESSION Senate Bill No. 473Introduced by Senator Bates(Coauthor: Senator Rubio)February 17, 2021An act to amend Section 1367.51 of the Health and Safety Code, and to amend Section 10176.61 of the Insurance Code, relating to health care coverage.LEGISLATIVE COUNSEL'S DIGESTSB 473, as amended, Bates. Health care coverage: insulin cost sharing.Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the acts requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan contract or health insurance policy issued, amended, delivered, or renewed on or after January 1, 2000, to include coverage for equipment, supplies, and, if the contract or policy covers prescription benefits, prescriptive medications for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes, as medically necessary.This bill would prohibit a health care service plan contract or a health insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2023, from imposing cost sharing on a covered insulin prescription, except for a copayment not to exceed $35 per month per each dosage form of insulin products. The bill would also prohibit a health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, from imposing a deductible requirement on benefits related to managing and treating diabetes, as specified. Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that no reimbursement is required by this act for a specified reason.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES Bill TextThe people of the State of California do enact as follows:SECTION 1. The Legislature finds and declares that:(a) Approximately 263,000 Californians are diagnosed with type 1 diabetes each year. Approximately 4,037,000 Californian adults have diabetes.(b) Every Californian with type 1 diabetes, and many with type 2 diabetes, rely on daily doses of insulin to survive.(c) Insulin prices have nearly tripled, creating financial hardships for people who rely on it to survive.(d) One in four people using insulin have reported insulin underuse due to the high cost of insulin.(e) Diabetes is the seventh leading cause of death and a leading cause of disabling and life-threatening complications, including heart disease, stroke, kidney failure, amputation of the lower extremities, and new cases of blindness among adults.(f) Studies have shown that managing diabetes can prevent the complications associated with diabetes.(g) Therefore, it is important to enact policies to reduce the costs for Californians with diabetes to obtain life-saving and life-sustaining insulin.SEC. 2. Section 1367.51 of the Health and Safety Code is amended to read:1367.51. (a) A health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2000, shall include coverage for the following equipment and supplies for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes as medically necessary, even if the items are available without a prescription:(1) Blood glucose monitors and blood glucose testing strips.(2) Blood glucose monitors designed to assist the visually impaired.(3) Insulin pumps and all related necessary supplies.(4) Ketone urine testing strips.(5) Lancets and lancet puncture devices.(6) Pen delivery systems for the administration of insulin.(7) Podiatric devices to prevent or treat diabetes-related complications.(8) Insulin syringes.(9) Visual aids, excluding eyewear, to assist the visually impaired with proper dosing of insulin.(b) A health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2000, that covers prescription benefits shall include coverage for the following prescription items if the items are determined to be medically necessary:(1) Insulin.(2) Prescriptive medications for the treatment of diabetes.(3) Glucagon.(c) The copayments and deductibles for the benefits specified in subdivisions (a) and (b) shall not exceed those established for similar benefits within the given plan.(d) (1) Notwithstanding subdivision (c), for a health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, the copayment for an insulin prescription covered pursuant to subdivision (b) shall not exceed thirty-five dollars ($35) per month per each dosage form of insulin products.(2) A health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible, coinsurance, or other cost-sharing requirement on an insulin prescription, except for a copayment subject to the limitations in paragraph (1).(3) Paragraphs (1) and (2) shall only apply to one of each dosage form and insulin type.(4) A health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible requirement on a benefit described in subdivision (a).(e) A health care service plan shall provide coverage for diabetes outpatient self-management training, education, and medical nutrition therapy necessary to enable an enrollee to properly use the equipment, supplies, and medications set forth in subdivisions (a) and (b), and additional diabetes outpatient self-management training, education, and medical nutrition therapy upon the direction or prescription of those services by the enrollees participating physician. If a plan delegates outpatient self-management training to contracting providers, the plan shall require contracting providers to ensure that diabetes outpatient self-management training, education, and medical nutrition therapy are provided by appropriately licensed or registered health care professionals.(f) The diabetes outpatient self-management training, education, and medical nutrition therapy services identified in subdivision (e) shall be provided by appropriately licensed or registered health care professionals as prescribed by a participating health care professional legally authorized to prescribe the service. These benefits shall include, but not be limited to, instruction that will enable diabetic patients and their families to gain an understanding of the diabetic disease process, and the daily management of diabetic therapy, in order to thereby avoid frequent hospitalizations and complications.(g) The copayments for the benefits specified in subdivision (e) shall not exceed those established for physician office visits by the plan.(h) A health care service plan governed by this section shall disclose the benefits covered pursuant to this section in the plans evidence of coverage and disclosure forms.(i) A health care service plan shall not reduce or eliminate coverage as a result of this section.(j) This section does not deny or restrict the departments authority to ensure plan compliance with this chapter if a plan provides coverage for prescription drugs.SEC. 3. Section 10176.61 of the Insurance Code is amended to read:10176.61. (a) A health insurance policy issued, amended, or renewed on or after January 1, 2000, shall include coverage for the following equipment and supplies for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes as medically necessary, even if the items are available without a prescription:(1) Blood glucose monitors and blood glucose testing strips.(2) Blood glucose monitors designed to assist the visually impaired.(3) Insulin pumps and all related necessary supplies.(4) Ketone urine testing strips.(5) Lancets and lancet puncture devices.(6) Pen delivery systems for the administration of insulin.(7) Podiatric devices to prevent or treat diabetes-related complications.(8) Insulin syringes.(9) Visual aids, excluding eyewear, to assist the visually impaired with proper dosing of insulin.(b) A health insurance policy that is issued, amended, or renewed on or after January 1, 2000, that covers prescription benefits shall include coverage for the following prescription items if the items are determined to be medically necessary:(1) Insulin.(2) Prescriptive medications for the treatment of diabetes.(3) Glucagon.(c) The coinsurances and deductibles for the benefits specified in subdivisions (a) and (b) shall not exceed those established for similar benefits within the given policy.(d) (1) Notwithstanding subdivision (c), for a health insurance policy that is issued, amended, or renewed on or after January 1, 2023, the copayment for an insulin prescription covered pursuant to subdivision (b) shall not exceed thirty-five dollars ($35) per month per each dosage form of insulin products.(2) A health insurance policy that is issued, amended, or renewed on or after January 1, 2023, shall not impose a deductible, coinsurance, or other cost-sharing requirement on an insulin prescription, except for a copayment subject to the limitations in paragraph (1).(3) Paragraphs (1) and (2) shall only apply to one of each dosage form and insulin type.(4) A health insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible requirement on a benefit described in subdivision (a).(e) A health insurer shall provide coverage for diabetes outpatient self-management training, education, and medical nutrition therapy necessary to enable an insured to properly use the equipment, supplies, and medications set forth in subdivisions (a) and (b) and additional diabetes outpatient self-management training, education, and medical nutrition therapy upon the direction or prescription of those services by the insureds participating physician. If an insurer delegates outpatient self-management training to contracting providers, the insurer shall require contracting providers to ensure that diabetes outpatient self-management training, education, and medical nutrition therapy are provided by appropriately licensed or registered health care professionals.(f) The diabetes outpatient self-management training, education, and medical nutrition therapy services identified in subdivision (e) shall be provided by appropriately licensed or registered health care professionals as prescribed by a health care professional legally authorized to prescribe the services.(g) The coinsurances and deductibles for the benefits specified in subdivision (e) shall not exceed those established for physician office visits by the insurer.(h) A health insurer governed by this section shall disclose the benefits covered pursuant to this section in the insurers evidence of coverage and disclosure forms.(i) A health insurer shall not reduce or eliminate coverage as a result of this section.(j) This section does not apply to vision-only, dental-only, accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, or disability income insurance, except that for accident-only, specified disease, and hospital indemnity insurance coverage, benefits under this section only apply to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy. This section does not impose a new benefit mandate on accident-only, specified disease, or hospital indemnity insurance.SEC. 4. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
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3- Amended IN Assembly June 16, 2022 Amended IN Senate January 13, 2022 Amended IN Senate January 03, 2022 Amended IN Senate March 10, 2021 CALIFORNIA LEGISLATURE 20212022 REGULAR SESSION Senate Bill No. 473Introduced by Senator Bates(Coauthor: Senator Rubio)February 17, 2021An act to amend Section 1367.51 of the Health and Safety Code, and to amend Section 10176.61 of the Insurance Code, relating to health care coverage.LEGISLATIVE COUNSEL'S DIGESTSB 473, as amended, Bates. Health care coverage: insulin cost sharing.Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the acts requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan contract or health insurance policy issued, amended, delivered, or renewed on or after January 1, 2000, to include coverage for equipment, supplies, and, if the contract or policy covers prescription benefits, prescriptive medications for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes, as medically necessary.This bill would prohibit require a health care service plan contract or a health insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2023, from imposing cost sharing on a covered insulin prescription, except to cover all available dosage forms and concentrations of at least one insulin product of each insulin type for a copayment not to exceed $35 per month per each dosage form of insulin products. for a monthly supply, or a multiple of $35 for a multimonth supply, and would prohibit a policy or contract from imposing other cost-sharing requirements. The bill would also prohibit a health care service plan contract or health insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2023, from imposing a deductible requirement on benefits related to managing and treating diabetes, as specified. Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that no reimbursement is required by this act for a specified reason.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES
3+ Amended IN Senate January 13, 2022 Amended IN Senate January 03, 2022 Amended IN Senate March 10, 2021 CALIFORNIA LEGISLATURE 20212022 REGULAR SESSION Senate Bill No. 473Introduced by Senator Bates(Coauthor: Senator Rubio)February 17, 2021An act to amend Section 1367.51 of the Health and Safety Code, and to amend Section 10176.61 of the Insurance Code, relating to health care coverage.LEGISLATIVE COUNSEL'S DIGESTSB 473, as amended, Bates. Health care coverage: insulin cost sharing.Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the acts requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan contract or health insurance policy issued, amended, delivered, or renewed on or after January 1, 2000, to include coverage for equipment, supplies, and, if the contract or policy covers prescription benefits, prescriptive medications for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes, as medically necessary.This bill would prohibit a health care service plan contract or a health insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2023, from imposing cost sharing on a covered insulin prescription, except for a copayment not to exceed $35 per month per each dosage form of insulin products. The bill would also prohibit a health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, from imposing a deductible requirement on benefits related to managing and treating diabetes, as specified. Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that no reimbursement is required by this act for a specified reason.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YES
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5- Amended IN Assembly June 16, 2022 Amended IN Senate January 13, 2022 Amended IN Senate January 03, 2022 Amended IN Senate March 10, 2021
5+ Amended IN Senate January 13, 2022 Amended IN Senate January 03, 2022 Amended IN Senate March 10, 2021
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7-Amended IN Assembly June 16, 2022
87 Amended IN Senate January 13, 2022
98 Amended IN Senate January 03, 2022
109 Amended IN Senate March 10, 2021
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1211 CALIFORNIA LEGISLATURE 20212022 REGULAR SESSION
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1413 Senate Bill
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1615 No. 473
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1817 Introduced by Senator Bates(Coauthor: Senator Rubio)February 17, 2021
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2019 Introduced by Senator Bates(Coauthor: Senator Rubio)
2120 February 17, 2021
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2322 An act to amend Section 1367.51 of the Health and Safety Code, and to amend Section 10176.61 of the Insurance Code, relating to health care coverage.
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2524 LEGISLATIVE COUNSEL'S DIGEST
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2726 ## LEGISLATIVE COUNSEL'S DIGEST
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2928 SB 473, as amended, Bates. Health care coverage: insulin cost sharing.
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31-Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the acts requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan contract or health insurance policy issued, amended, delivered, or renewed on or after January 1, 2000, to include coverage for equipment, supplies, and, if the contract or policy covers prescription benefits, prescriptive medications for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes, as medically necessary.This bill would prohibit require a health care service plan contract or a health insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2023, from imposing cost sharing on a covered insulin prescription, except to cover all available dosage forms and concentrations of at least one insulin product of each insulin type for a copayment not to exceed $35 per month per each dosage form of insulin products. for a monthly supply, or a multiple of $35 for a multimonth supply, and would prohibit a policy or contract from imposing other cost-sharing requirements. The bill would also prohibit a health care service plan contract or health insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2023, from imposing a deductible requirement on benefits related to managing and treating diabetes, as specified. Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that no reimbursement is required by this act for a specified reason.
30+Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the acts requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan contract or health insurance policy issued, amended, delivered, or renewed on or after January 1, 2000, to include coverage for equipment, supplies, and, if the contract or policy covers prescription benefits, prescriptive medications for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes, as medically necessary.This bill would prohibit a health care service plan contract or a health insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2023, from imposing cost sharing on a covered insulin prescription, except for a copayment not to exceed $35 per month per each dosage form of insulin products. The bill would also prohibit a health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, from imposing a deductible requirement on benefits related to managing and treating diabetes, as specified. Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.This bill would provide that no reimbursement is required by this act for a specified reason.
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3332 Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the acts requirements a crime. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health care service plan contract or health insurance policy issued, amended, delivered, or renewed on or after January 1, 2000, to include coverage for equipment, supplies, and, if the contract or policy covers prescription benefits, prescriptive medications for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes, as medically necessary.
3433
35-This bill would prohibit require a health care service plan contract or a health insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2023, from imposing cost sharing on a covered insulin prescription, except to cover all available dosage forms and concentrations of at least one insulin product of each insulin type for a copayment not to exceed $35 per month per each dosage form of insulin products. for a monthly supply, or a multiple of $35 for a multimonth supply, and would prohibit a policy or contract from imposing other cost-sharing requirements. The bill would also prohibit a health care service plan contract or health insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2023, from imposing a deductible requirement on benefits related to managing and treating diabetes, as specified. Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.
34+This bill would prohibit a health care service plan contract or a health insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2023, from imposing cost sharing on a covered insulin prescription, except for a copayment not to exceed $35 per month per each dosage form of insulin products. The bill would also prohibit a health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, from imposing a deductible requirement on benefits related to managing and treating diabetes, as specified. Because a willful violation of these provisions by a health care service plan would be a crime, the bill would impose a state-mandated local program.
3635
3736 The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
3837
3938 This bill would provide that no reimbursement is required by this act for a specified reason.
4039
4140 ## Digest Key
4241
4342 ## Bill Text
4443
45-The people of the State of California do enact as follows:SECTION 1. The Legislature finds and declares that:(a) Approximately 263,000 Californians are diagnosed with type 1 diabetes each year. Approximately 4,037,000 Californian adults have diabetes.(b) Every Californian with type 1 diabetes, and many with type 2 diabetes, rely on daily doses of insulin to survive.(c) Insulin prices have nearly tripled, creating financial hardships for people who rely on it to survive.(d) One in four people using insulin have reported insulin underuse due to the high cost of insulin.(e) Diabetes is the seventh leading cause of death and a leading cause of disabling and life-threatening complications, including heart disease, stroke, kidney failure, amputation of the lower extremities, and new cases of blindness among adults.(f) Studies have shown that managing diabetes can prevent the complications associated with diabetes.(g) Therefore, it is important to enact policies to reduce the costs for Californians with diabetes to obtain life-saving and life-sustaining insulin.SEC. 2. Section 1367.51 of the Health and Safety Code is amended to read:1367.51. (a) A health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2000, shall include coverage for the following equipment and supplies for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes as medically necessary, even if the items are available without a prescription:(1) Blood glucose monitors and blood glucose testing strips.(2) Blood glucose monitors designed to assist the visually impaired.(3) Insulin pumps and all related necessary supplies.(4) Ketone urine testing strips.(5) Lancets and lancet puncture devices.(6) Pen delivery systems for the administration of insulin.(7) Podiatric devices to prevent or treat diabetes-related complications.(8) Insulin syringes.(9) Visual aids, excluding eyewear, to assist the visually impaired with proper dosing of insulin.(b) A health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2000, that covers prescription drug benefits shall include coverage for the following prescription items if the items are determined to be medically necessary:(1) Insulin.(2) Prescriptive medications for the treatment of diabetes.(3) Glucagon.(c) The copayments and deductibles for the benefits specified in subdivisions (a) and (b) shall not exceed those established for similar benefits within the given plan.(d) (1) Notwithstanding subdivision (c), for a health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, the copayment for an insulin prescription covered pursuant to subdivision (b) shall not exceed thirty-five dollars ($35) per month per each dosage form of insulin products. shall cover all available dosage forms and concentrations of at least one insulin product of each insulin type for a copayment of no more than thirty-five dollars ($35) for a monthly supply. If a contract covers prescription drugs in larger amounts than a monthly supply, the copayment on that amount shall be equal to or less than the multiple of the monthly supply copayment, so that the respective copayment for a 60-day or 90-day supply shall not exceed seventy dollars ($70) or one hundred five dollars ($105).(2) A health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible, coinsurance, or other cost-sharing requirement on an insulin prescription, prescription covered pursuant to paragraph (1), except for a copayment subject to the limitations in paragraph (1).(3)Paragraphs (1) and (2) shall only apply to one of each dosage form and insulin type.(3) For purposes of this subdivision:(A) Dosage form means the form in which insulin is packaged, including vial and pen delivery device.(B) Insulin type means rapid-acting, short-acting, intermediate-acting, or long-acting insulin.(4)(e) A health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible requirement on a benefit described in subdivision (a). If a health care service plan contract is a high deductible health plan, as defined in Section 223(c)(2) of Title 26 of the United States Code, the contract shall not impose a deductible requirement on a benefit described in paragraph (1) or (2) of subdivision (a), or any other benefit described in subdivision (a) for which the Internal Revenue Service has indicated that the minimum deductible may be waived in a high deductible health plan.(e)(f) A health care service plan shall provide coverage for diabetes outpatient self-management training, education, and medical nutrition therapy necessary to enable an enrollee to properly use the equipment, supplies, and medications set forth in subdivisions (a) and (b), and additional diabetes outpatient self-management training, education, and medical nutrition therapy upon the direction or prescription of those services by the enrollees participating physician. If a plan delegates outpatient self-management training to contracting providers, the plan shall require contracting providers to ensure that diabetes outpatient self-management training, education, and medical nutrition therapy are provided by appropriately licensed or registered health care professionals.(f)(g) The diabetes outpatient self-management training, education, and medical nutrition therapy services identified in subdivision (e) (f) shall be provided by appropriately licensed or registered health care professionals as prescribed by a participating health care professional legally authorized to prescribe the service. These benefits shall include, but not be limited to, instruction that will enable diabetic patients and their families to gain an understanding of the diabetic disease process, and the daily management of diabetic therapy, in order to thereby avoid frequent hospitalizations and complications.(g)(h) The copayments for the benefits specified in subdivision (e) (f) shall not exceed those established for physician office visits by the plan.(h)(i) A health care service plan governed by this section shall disclose the benefits covered pursuant to this section in the plans evidence of coverage and disclosure contract forms.(i)(j) A health care service plan shall not reduce or eliminate coverage as a result of this section.(j)(k) This section does not deny or restrict the departments authority to ensure plan compliance with this chapter if a plan provides coverage for prescription drugs.SEC. 3. Section 10176.61 of the Insurance Code is amended to read:10176.61. (a) A health insurance policy issued, amended, or renewed on or after January 1, 2000, shall include coverage for the following equipment and supplies for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes as medically necessary, even if the items are available without a prescription:(1) Blood glucose monitors and blood glucose testing strips.(2) Blood glucose monitors designed to assist the visually impaired.(3) Insulin pumps and all related necessary supplies.(4) Ketone urine testing strips.(5) Lancets and lancet puncture devices.(6) Pen delivery systems for the administration of insulin.(7) Podiatric devices to prevent or treat diabetes-related complications.(8) Insulin syringes.(9) Visual aids, excluding eyewear, to assist the visually impaired with proper dosing of insulin.(b) A health insurance policy that is issued, amended, or renewed on or after January 1, 2000, that covers prescription drug benefits shall include coverage for the following prescription items if the items are determined to be medically necessary:(1) Insulin.(2) Prescriptive medications for the treatment of diabetes.(3) Glucagon.(c) The coinsurances and deductibles for the benefits specified in subdivisions (a) and (b) shall not exceed those established for similar benefits within the given policy.(d) (1) Notwithstanding subdivision (c), for a health insurance policy that is issued, amended, or renewed on or after January 1, 2023, the copayment for an insulin prescription covered pursuant to subdivision (b) shall not exceed thirty-five dollars ($35) per month per each dosage form of insulin products. shall cover all available dosage forms and concentrations of at least one insulin product of each insulin type for a copayment of no more than thirty-five dollars ($35) for a monthly supply. If a policy covers prescription drugs in larger amounts than a monthly supply, the copayment on that amount shall be equal to or less than the multiple of the monthly supply copayment, so that the respective copayment for a 60-day or 90-day supply shall not exceed seventy dollars ($70) or one hundred five dollars ($105).(2) A health insurance policy that is issued, amended, or renewed on or after January 1, 2023, shall not impose a deductible, coinsurance, or other cost-sharing requirement on an insulin prescription, prescription covered pursuant to paragraph (1), except for a copayment subject to the limitations in paragraph (1).(3)Paragraphs (1) and (2) shall only apply to one of each dosage form and insulin type.(3) For purposes of this subdivision:(A) Dosage form means the form in which insulin is packaged, including vial and pen delivery device.(B) Insulin type means rapid-acting, short-acting, intermediate-acting, or long-acting insulin.(4)(e) A health insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible requirement on a benefit described in subdivision (a). If a health insurance policy is a high deductible health plan, as defined in Section 223(c)(2) of Title 26 of the United States Code, the policy shall not impose a deductible requirement on a benefit described in paragraph (1) or (2) of subdivision (a), or any other benefit described in subdivision (a) for which the Internal Revenue Service has indicated that the minimum deductible may be waived in a high deductible health plan.(e)(f) A health insurer shall provide coverage for diabetes outpatient self-management training, education, and medical nutrition therapy necessary to enable an insured to properly use the equipment, supplies, and medications set forth in subdivisions (a) and (b) and additional diabetes outpatient self-management training, education, and medical nutrition therapy upon the direction or prescription of those services by the insureds participating physician. If an insurer delegates outpatient self-management training to contracting providers, the insurer shall require contracting providers to ensure that diabetes outpatient self-management training, education, and medical nutrition therapy are provided by appropriately licensed or registered health care professionals.(f)(g) The diabetes outpatient self-management training, education, and medical nutrition therapy services identified in subdivision (e) (f) shall be provided by appropriately licensed or registered health care professionals as prescribed by a health care professional legally authorized to prescribe the services.(g)(h) The coinsurances and deductibles for the benefits specified in subdivision (e) (f) shall not exceed those established for physician office visits by the insurer.(h)(i) A health insurer governed by this section shall disclose the benefits covered pursuant to this section in the insurers evidence of coverage and disclosure policy forms.(i)(j) A health insurer shall not reduce or eliminate coverage as a result of this section.(j)(k) This section does not apply to vision-only, dental-only, accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, or disability income insurance, except that for accident-only, specified disease, and hospital indemnity insurance coverage, benefits under this section only apply to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy. This section does not impose a new benefit mandate on accident-only, specified disease, or hospital indemnity insurance.SEC. 4. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
44+The people of the State of California do enact as follows:SECTION 1. The Legislature finds and declares that:(a) Approximately 263,000 Californians are diagnosed with type 1 diabetes each year. Approximately 4,037,000 Californian adults have diabetes.(b) Every Californian with type 1 diabetes, and many with type 2 diabetes, rely on daily doses of insulin to survive.(c) Insulin prices have nearly tripled, creating financial hardships for people who rely on it to survive.(d) One in four people using insulin have reported insulin underuse due to the high cost of insulin.(e) Diabetes is the seventh leading cause of death and a leading cause of disabling and life-threatening complications, including heart disease, stroke, kidney failure, amputation of the lower extremities, and new cases of blindness among adults.(f) Studies have shown that managing diabetes can prevent the complications associated with diabetes.(g) Therefore, it is important to enact policies to reduce the costs for Californians with diabetes to obtain life-saving and life-sustaining insulin.SEC. 2. Section 1367.51 of the Health and Safety Code is amended to read:1367.51. (a) A health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2000, shall include coverage for the following equipment and supplies for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes as medically necessary, even if the items are available without a prescription:(1) Blood glucose monitors and blood glucose testing strips.(2) Blood glucose monitors designed to assist the visually impaired.(3) Insulin pumps and all related necessary supplies.(4) Ketone urine testing strips.(5) Lancets and lancet puncture devices.(6) Pen delivery systems for the administration of insulin.(7) Podiatric devices to prevent or treat diabetes-related complications.(8) Insulin syringes.(9) Visual aids, excluding eyewear, to assist the visually impaired with proper dosing of insulin.(b) A health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2000, that covers prescription benefits shall include coverage for the following prescription items if the items are determined to be medically necessary:(1) Insulin.(2) Prescriptive medications for the treatment of diabetes.(3) Glucagon.(c) The copayments and deductibles for the benefits specified in subdivisions (a) and (b) shall not exceed those established for similar benefits within the given plan.(d) (1) Notwithstanding subdivision (c), for a health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, the copayment for an insulin prescription covered pursuant to subdivision (b) shall not exceed thirty-five dollars ($35) per month per each dosage form of insulin products.(2) A health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible, coinsurance, or other cost-sharing requirement on an insulin prescription, except for a copayment subject to the limitations in paragraph (1).(3) Paragraphs (1) and (2) shall only apply to one of each dosage form and insulin type.(4) A health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible requirement on a benefit described in subdivision (a).(e) A health care service plan shall provide coverage for diabetes outpatient self-management training, education, and medical nutrition therapy necessary to enable an enrollee to properly use the equipment, supplies, and medications set forth in subdivisions (a) and (b), and additional diabetes outpatient self-management training, education, and medical nutrition therapy upon the direction or prescription of those services by the enrollees participating physician. If a plan delegates outpatient self-management training to contracting providers, the plan shall require contracting providers to ensure that diabetes outpatient self-management training, education, and medical nutrition therapy are provided by appropriately licensed or registered health care professionals.(f) The diabetes outpatient self-management training, education, and medical nutrition therapy services identified in subdivision (e) shall be provided by appropriately licensed or registered health care professionals as prescribed by a participating health care professional legally authorized to prescribe the service. These benefits shall include, but not be limited to, instruction that will enable diabetic patients and their families to gain an understanding of the diabetic disease process, and the daily management of diabetic therapy, in order to thereby avoid frequent hospitalizations and complications.(g) The copayments for the benefits specified in subdivision (e) shall not exceed those established for physician office visits by the plan.(h) A health care service plan governed by this section shall disclose the benefits covered pursuant to this section in the plans evidence of coverage and disclosure forms.(i) A health care service plan shall not reduce or eliminate coverage as a result of this section.(j) This section does not deny or restrict the departments authority to ensure plan compliance with this chapter if a plan provides coverage for prescription drugs.SEC. 3. Section 10176.61 of the Insurance Code is amended to read:10176.61. (a) A health insurance policy issued, amended, or renewed on or after January 1, 2000, shall include coverage for the following equipment and supplies for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes as medically necessary, even if the items are available without a prescription:(1) Blood glucose monitors and blood glucose testing strips.(2) Blood glucose monitors designed to assist the visually impaired.(3) Insulin pumps and all related necessary supplies.(4) Ketone urine testing strips.(5) Lancets and lancet puncture devices.(6) Pen delivery systems for the administration of insulin.(7) Podiatric devices to prevent or treat diabetes-related complications.(8) Insulin syringes.(9) Visual aids, excluding eyewear, to assist the visually impaired with proper dosing of insulin.(b) A health insurance policy that is issued, amended, or renewed on or after January 1, 2000, that covers prescription benefits shall include coverage for the following prescription items if the items are determined to be medically necessary:(1) Insulin.(2) Prescriptive medications for the treatment of diabetes.(3) Glucagon.(c) The coinsurances and deductibles for the benefits specified in subdivisions (a) and (b) shall not exceed those established for similar benefits within the given policy.(d) (1) Notwithstanding subdivision (c), for a health insurance policy that is issued, amended, or renewed on or after January 1, 2023, the copayment for an insulin prescription covered pursuant to subdivision (b) shall not exceed thirty-five dollars ($35) per month per each dosage form of insulin products.(2) A health insurance policy that is issued, amended, or renewed on or after January 1, 2023, shall not impose a deductible, coinsurance, or other cost-sharing requirement on an insulin prescription, except for a copayment subject to the limitations in paragraph (1).(3) Paragraphs (1) and (2) shall only apply to one of each dosage form and insulin type.(4) A health insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible requirement on a benefit described in subdivision (a).(e) A health insurer shall provide coverage for diabetes outpatient self-management training, education, and medical nutrition therapy necessary to enable an insured to properly use the equipment, supplies, and medications set forth in subdivisions (a) and (b) and additional diabetes outpatient self-management training, education, and medical nutrition therapy upon the direction or prescription of those services by the insureds participating physician. If an insurer delegates outpatient self-management training to contracting providers, the insurer shall require contracting providers to ensure that diabetes outpatient self-management training, education, and medical nutrition therapy are provided by appropriately licensed or registered health care professionals.(f) The diabetes outpatient self-management training, education, and medical nutrition therapy services identified in subdivision (e) shall be provided by appropriately licensed or registered health care professionals as prescribed by a health care professional legally authorized to prescribe the services.(g) The coinsurances and deductibles for the benefits specified in subdivision (e) shall not exceed those established for physician office visits by the insurer.(h) A health insurer governed by this section shall disclose the benefits covered pursuant to this section in the insurers evidence of coverage and disclosure forms.(i) A health insurer shall not reduce or eliminate coverage as a result of this section.(j) This section does not apply to vision-only, dental-only, accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, or disability income insurance, except that for accident-only, specified disease, and hospital indemnity insurance coverage, benefits under this section only apply to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy. This section does not impose a new benefit mandate on accident-only, specified disease, or hospital indemnity insurance.SEC. 4. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
4645
4746 The people of the State of California do enact as follows:
4847
4948 ## The people of the State of California do enact as follows:
5049
5150 SECTION 1. The Legislature finds and declares that:(a) Approximately 263,000 Californians are diagnosed with type 1 diabetes each year. Approximately 4,037,000 Californian adults have diabetes.(b) Every Californian with type 1 diabetes, and many with type 2 diabetes, rely on daily doses of insulin to survive.(c) Insulin prices have nearly tripled, creating financial hardships for people who rely on it to survive.(d) One in four people using insulin have reported insulin underuse due to the high cost of insulin.(e) Diabetes is the seventh leading cause of death and a leading cause of disabling and life-threatening complications, including heart disease, stroke, kidney failure, amputation of the lower extremities, and new cases of blindness among adults.(f) Studies have shown that managing diabetes can prevent the complications associated with diabetes.(g) Therefore, it is important to enact policies to reduce the costs for Californians with diabetes to obtain life-saving and life-sustaining insulin.
5251
5352 SECTION 1. The Legislature finds and declares that:(a) Approximately 263,000 Californians are diagnosed with type 1 diabetes each year. Approximately 4,037,000 Californian adults have diabetes.(b) Every Californian with type 1 diabetes, and many with type 2 diabetes, rely on daily doses of insulin to survive.(c) Insulin prices have nearly tripled, creating financial hardships for people who rely on it to survive.(d) One in four people using insulin have reported insulin underuse due to the high cost of insulin.(e) Diabetes is the seventh leading cause of death and a leading cause of disabling and life-threatening complications, including heart disease, stroke, kidney failure, amputation of the lower extremities, and new cases of blindness among adults.(f) Studies have shown that managing diabetes can prevent the complications associated with diabetes.(g) Therefore, it is important to enact policies to reduce the costs for Californians with diabetes to obtain life-saving and life-sustaining insulin.
5453
5554 SECTION 1. The Legislature finds and declares that:
5655
5756 ### SECTION 1.
5857
5958 (a) Approximately 263,000 Californians are diagnosed with type 1 diabetes each year. Approximately 4,037,000 Californian adults have diabetes.
6059
6160 (b) Every Californian with type 1 diabetes, and many with type 2 diabetes, rely on daily doses of insulin to survive.
6261
6362 (c) Insulin prices have nearly tripled, creating financial hardships for people who rely on it to survive.
6463
6564 (d) One in four people using insulin have reported insulin underuse due to the high cost of insulin.
6665
6766 (e) Diabetes is the seventh leading cause of death and a leading cause of disabling and life-threatening complications, including heart disease, stroke, kidney failure, amputation of the lower extremities, and new cases of blindness among adults.
6867
6968 (f) Studies have shown that managing diabetes can prevent the complications associated with diabetes.
7069
7170 (g) Therefore, it is important to enact policies to reduce the costs for Californians with diabetes to obtain life-saving and life-sustaining insulin.
7271
73-SEC. 2. Section 1367.51 of the Health and Safety Code is amended to read:1367.51. (a) A health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2000, shall include coverage for the following equipment and supplies for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes as medically necessary, even if the items are available without a prescription:(1) Blood glucose monitors and blood glucose testing strips.(2) Blood glucose monitors designed to assist the visually impaired.(3) Insulin pumps and all related necessary supplies.(4) Ketone urine testing strips.(5) Lancets and lancet puncture devices.(6) Pen delivery systems for the administration of insulin.(7) Podiatric devices to prevent or treat diabetes-related complications.(8) Insulin syringes.(9) Visual aids, excluding eyewear, to assist the visually impaired with proper dosing of insulin.(b) A health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2000, that covers prescription drug benefits shall include coverage for the following prescription items if the items are determined to be medically necessary:(1) Insulin.(2) Prescriptive medications for the treatment of diabetes.(3) Glucagon.(c) The copayments and deductibles for the benefits specified in subdivisions (a) and (b) shall not exceed those established for similar benefits within the given plan.(d) (1) Notwithstanding subdivision (c), for a health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, the copayment for an insulin prescription covered pursuant to subdivision (b) shall not exceed thirty-five dollars ($35) per month per each dosage form of insulin products. shall cover all available dosage forms and concentrations of at least one insulin product of each insulin type for a copayment of no more than thirty-five dollars ($35) for a monthly supply. If a contract covers prescription drugs in larger amounts than a monthly supply, the copayment on that amount shall be equal to or less than the multiple of the monthly supply copayment, so that the respective copayment for a 60-day or 90-day supply shall not exceed seventy dollars ($70) or one hundred five dollars ($105).(2) A health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible, coinsurance, or other cost-sharing requirement on an insulin prescription, prescription covered pursuant to paragraph (1), except for a copayment subject to the limitations in paragraph (1).(3)Paragraphs (1) and (2) shall only apply to one of each dosage form and insulin type.(3) For purposes of this subdivision:(A) Dosage form means the form in which insulin is packaged, including vial and pen delivery device.(B) Insulin type means rapid-acting, short-acting, intermediate-acting, or long-acting insulin.(4)(e) A health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible requirement on a benefit described in subdivision (a). If a health care service plan contract is a high deductible health plan, as defined in Section 223(c)(2) of Title 26 of the United States Code, the contract shall not impose a deductible requirement on a benefit described in paragraph (1) or (2) of subdivision (a), or any other benefit described in subdivision (a) for which the Internal Revenue Service has indicated that the minimum deductible may be waived in a high deductible health plan.(e)(f) A health care service plan shall provide coverage for diabetes outpatient self-management training, education, and medical nutrition therapy necessary to enable an enrollee to properly use the equipment, supplies, and medications set forth in subdivisions (a) and (b), and additional diabetes outpatient self-management training, education, and medical nutrition therapy upon the direction or prescription of those services by the enrollees participating physician. If a plan delegates outpatient self-management training to contracting providers, the plan shall require contracting providers to ensure that diabetes outpatient self-management training, education, and medical nutrition therapy are provided by appropriately licensed or registered health care professionals.(f)(g) The diabetes outpatient self-management training, education, and medical nutrition therapy services identified in subdivision (e) (f) shall be provided by appropriately licensed or registered health care professionals as prescribed by a participating health care professional legally authorized to prescribe the service. These benefits shall include, but not be limited to, instruction that will enable diabetic patients and their families to gain an understanding of the diabetic disease process, and the daily management of diabetic therapy, in order to thereby avoid frequent hospitalizations and complications.(g)(h) The copayments for the benefits specified in subdivision (e) (f) shall not exceed those established for physician office visits by the plan.(h)(i) A health care service plan governed by this section shall disclose the benefits covered pursuant to this section in the plans evidence of coverage and disclosure contract forms.(i)(j) A health care service plan shall not reduce or eliminate coverage as a result of this section.(j)(k) This section does not deny or restrict the departments authority to ensure plan compliance with this chapter if a plan provides coverage for prescription drugs.
72+SEC. 2. Section 1367.51 of the Health and Safety Code is amended to read:1367.51. (a) A health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2000, shall include coverage for the following equipment and supplies for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes as medically necessary, even if the items are available without a prescription:(1) Blood glucose monitors and blood glucose testing strips.(2) Blood glucose monitors designed to assist the visually impaired.(3) Insulin pumps and all related necessary supplies.(4) Ketone urine testing strips.(5) Lancets and lancet puncture devices.(6) Pen delivery systems for the administration of insulin.(7) Podiatric devices to prevent or treat diabetes-related complications.(8) Insulin syringes.(9) Visual aids, excluding eyewear, to assist the visually impaired with proper dosing of insulin.(b) A health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2000, that covers prescription benefits shall include coverage for the following prescription items if the items are determined to be medically necessary:(1) Insulin.(2) Prescriptive medications for the treatment of diabetes.(3) Glucagon.(c) The copayments and deductibles for the benefits specified in subdivisions (a) and (b) shall not exceed those established for similar benefits within the given plan.(d) (1) Notwithstanding subdivision (c), for a health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, the copayment for an insulin prescription covered pursuant to subdivision (b) shall not exceed thirty-five dollars ($35) per month per each dosage form of insulin products.(2) A health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible, coinsurance, or other cost-sharing requirement on an insulin prescription, except for a copayment subject to the limitations in paragraph (1).(3) Paragraphs (1) and (2) shall only apply to one of each dosage form and insulin type.(4) A health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible requirement on a benefit described in subdivision (a).(e) A health care service plan shall provide coverage for diabetes outpatient self-management training, education, and medical nutrition therapy necessary to enable an enrollee to properly use the equipment, supplies, and medications set forth in subdivisions (a) and (b), and additional diabetes outpatient self-management training, education, and medical nutrition therapy upon the direction or prescription of those services by the enrollees participating physician. If a plan delegates outpatient self-management training to contracting providers, the plan shall require contracting providers to ensure that diabetes outpatient self-management training, education, and medical nutrition therapy are provided by appropriately licensed or registered health care professionals.(f) The diabetes outpatient self-management training, education, and medical nutrition therapy services identified in subdivision (e) shall be provided by appropriately licensed or registered health care professionals as prescribed by a participating health care professional legally authorized to prescribe the service. These benefits shall include, but not be limited to, instruction that will enable diabetic patients and their families to gain an understanding of the diabetic disease process, and the daily management of diabetic therapy, in order to thereby avoid frequent hospitalizations and complications.(g) The copayments for the benefits specified in subdivision (e) shall not exceed those established for physician office visits by the plan.(h) A health care service plan governed by this section shall disclose the benefits covered pursuant to this section in the plans evidence of coverage and disclosure forms.(i) A health care service plan shall not reduce or eliminate coverage as a result of this section.(j) This section does not deny or restrict the departments authority to ensure plan compliance with this chapter if a plan provides coverage for prescription drugs.
7473
7574 SEC. 2. Section 1367.51 of the Health and Safety Code is amended to read:
7675
7776 ### SEC. 2.
7877
79-1367.51. (a) A health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2000, shall include coverage for the following equipment and supplies for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes as medically necessary, even if the items are available without a prescription:(1) Blood glucose monitors and blood glucose testing strips.(2) Blood glucose monitors designed to assist the visually impaired.(3) Insulin pumps and all related necessary supplies.(4) Ketone urine testing strips.(5) Lancets and lancet puncture devices.(6) Pen delivery systems for the administration of insulin.(7) Podiatric devices to prevent or treat diabetes-related complications.(8) Insulin syringes.(9) Visual aids, excluding eyewear, to assist the visually impaired with proper dosing of insulin.(b) A health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2000, that covers prescription drug benefits shall include coverage for the following prescription items if the items are determined to be medically necessary:(1) Insulin.(2) Prescriptive medications for the treatment of diabetes.(3) Glucagon.(c) The copayments and deductibles for the benefits specified in subdivisions (a) and (b) shall not exceed those established for similar benefits within the given plan.(d) (1) Notwithstanding subdivision (c), for a health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, the copayment for an insulin prescription covered pursuant to subdivision (b) shall not exceed thirty-five dollars ($35) per month per each dosage form of insulin products. shall cover all available dosage forms and concentrations of at least one insulin product of each insulin type for a copayment of no more than thirty-five dollars ($35) for a monthly supply. If a contract covers prescription drugs in larger amounts than a monthly supply, the copayment on that amount shall be equal to or less than the multiple of the monthly supply copayment, so that the respective copayment for a 60-day or 90-day supply shall not exceed seventy dollars ($70) or one hundred five dollars ($105).(2) A health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible, coinsurance, or other cost-sharing requirement on an insulin prescription, prescription covered pursuant to paragraph (1), except for a copayment subject to the limitations in paragraph (1).(3)Paragraphs (1) and (2) shall only apply to one of each dosage form and insulin type.(3) For purposes of this subdivision:(A) Dosage form means the form in which insulin is packaged, including vial and pen delivery device.(B) Insulin type means rapid-acting, short-acting, intermediate-acting, or long-acting insulin.(4)(e) A health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible requirement on a benefit described in subdivision (a). If a health care service plan contract is a high deductible health plan, as defined in Section 223(c)(2) of Title 26 of the United States Code, the contract shall not impose a deductible requirement on a benefit described in paragraph (1) or (2) of subdivision (a), or any other benefit described in subdivision (a) for which the Internal Revenue Service has indicated that the minimum deductible may be waived in a high deductible health plan.(e)(f) A health care service plan shall provide coverage for diabetes outpatient self-management training, education, and medical nutrition therapy necessary to enable an enrollee to properly use the equipment, supplies, and medications set forth in subdivisions (a) and (b), and additional diabetes outpatient self-management training, education, and medical nutrition therapy upon the direction or prescription of those services by the enrollees participating physician. If a plan delegates outpatient self-management training to contracting providers, the plan shall require contracting providers to ensure that diabetes outpatient self-management training, education, and medical nutrition therapy are provided by appropriately licensed or registered health care professionals.(f)(g) The diabetes outpatient self-management training, education, and medical nutrition therapy services identified in subdivision (e) (f) shall be provided by appropriately licensed or registered health care professionals as prescribed by a participating health care professional legally authorized to prescribe the service. These benefits shall include, but not be limited to, instruction that will enable diabetic patients and their families to gain an understanding of the diabetic disease process, and the daily management of diabetic therapy, in order to thereby avoid frequent hospitalizations and complications.(g)(h) The copayments for the benefits specified in subdivision (e) (f) shall not exceed those established for physician office visits by the plan.(h)(i) A health care service plan governed by this section shall disclose the benefits covered pursuant to this section in the plans evidence of coverage and disclosure contract forms.(i)(j) A health care service plan shall not reduce or eliminate coverage as a result of this section.(j)(k) This section does not deny or restrict the departments authority to ensure plan compliance with this chapter if a plan provides coverage for prescription drugs.
78+1367.51. (a) A health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2000, shall include coverage for the following equipment and supplies for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes as medically necessary, even if the items are available without a prescription:(1) Blood glucose monitors and blood glucose testing strips.(2) Blood glucose monitors designed to assist the visually impaired.(3) Insulin pumps and all related necessary supplies.(4) Ketone urine testing strips.(5) Lancets and lancet puncture devices.(6) Pen delivery systems for the administration of insulin.(7) Podiatric devices to prevent or treat diabetes-related complications.(8) Insulin syringes.(9) Visual aids, excluding eyewear, to assist the visually impaired with proper dosing of insulin.(b) A health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2000, that covers prescription benefits shall include coverage for the following prescription items if the items are determined to be medically necessary:(1) Insulin.(2) Prescriptive medications for the treatment of diabetes.(3) Glucagon.(c) The copayments and deductibles for the benefits specified in subdivisions (a) and (b) shall not exceed those established for similar benefits within the given plan.(d) (1) Notwithstanding subdivision (c), for a health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, the copayment for an insulin prescription covered pursuant to subdivision (b) shall not exceed thirty-five dollars ($35) per month per each dosage form of insulin products.(2) A health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible, coinsurance, or other cost-sharing requirement on an insulin prescription, except for a copayment subject to the limitations in paragraph (1).(3) Paragraphs (1) and (2) shall only apply to one of each dosage form and insulin type.(4) A health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible requirement on a benefit described in subdivision (a).(e) A health care service plan shall provide coverage for diabetes outpatient self-management training, education, and medical nutrition therapy necessary to enable an enrollee to properly use the equipment, supplies, and medications set forth in subdivisions (a) and (b), and additional diabetes outpatient self-management training, education, and medical nutrition therapy upon the direction or prescription of those services by the enrollees participating physician. If a plan delegates outpatient self-management training to contracting providers, the plan shall require contracting providers to ensure that diabetes outpatient self-management training, education, and medical nutrition therapy are provided by appropriately licensed or registered health care professionals.(f) The diabetes outpatient self-management training, education, and medical nutrition therapy services identified in subdivision (e) shall be provided by appropriately licensed or registered health care professionals as prescribed by a participating health care professional legally authorized to prescribe the service. These benefits shall include, but not be limited to, instruction that will enable diabetic patients and their families to gain an understanding of the diabetic disease process, and the daily management of diabetic therapy, in order to thereby avoid frequent hospitalizations and complications.(g) The copayments for the benefits specified in subdivision (e) shall not exceed those established for physician office visits by the plan.(h) A health care service plan governed by this section shall disclose the benefits covered pursuant to this section in the plans evidence of coverage and disclosure forms.(i) A health care service plan shall not reduce or eliminate coverage as a result of this section.(j) This section does not deny or restrict the departments authority to ensure plan compliance with this chapter if a plan provides coverage for prescription drugs.
8079
81-1367.51. (a) A health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2000, shall include coverage for the following equipment and supplies for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes as medically necessary, even if the items are available without a prescription:(1) Blood glucose monitors and blood glucose testing strips.(2) Blood glucose monitors designed to assist the visually impaired.(3) Insulin pumps and all related necessary supplies.(4) Ketone urine testing strips.(5) Lancets and lancet puncture devices.(6) Pen delivery systems for the administration of insulin.(7) Podiatric devices to prevent or treat diabetes-related complications.(8) Insulin syringes.(9) Visual aids, excluding eyewear, to assist the visually impaired with proper dosing of insulin.(b) A health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2000, that covers prescription drug benefits shall include coverage for the following prescription items if the items are determined to be medically necessary:(1) Insulin.(2) Prescriptive medications for the treatment of diabetes.(3) Glucagon.(c) The copayments and deductibles for the benefits specified in subdivisions (a) and (b) shall not exceed those established for similar benefits within the given plan.(d) (1) Notwithstanding subdivision (c), for a health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, the copayment for an insulin prescription covered pursuant to subdivision (b) shall not exceed thirty-five dollars ($35) per month per each dosage form of insulin products. shall cover all available dosage forms and concentrations of at least one insulin product of each insulin type for a copayment of no more than thirty-five dollars ($35) for a monthly supply. If a contract covers prescription drugs in larger amounts than a monthly supply, the copayment on that amount shall be equal to or less than the multiple of the monthly supply copayment, so that the respective copayment for a 60-day or 90-day supply shall not exceed seventy dollars ($70) or one hundred five dollars ($105).(2) A health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible, coinsurance, or other cost-sharing requirement on an insulin prescription, prescription covered pursuant to paragraph (1), except for a copayment subject to the limitations in paragraph (1).(3)Paragraphs (1) and (2) shall only apply to one of each dosage form and insulin type.(3) For purposes of this subdivision:(A) Dosage form means the form in which insulin is packaged, including vial and pen delivery device.(B) Insulin type means rapid-acting, short-acting, intermediate-acting, or long-acting insulin.(4)(e) A health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible requirement on a benefit described in subdivision (a). If a health care service plan contract is a high deductible health plan, as defined in Section 223(c)(2) of Title 26 of the United States Code, the contract shall not impose a deductible requirement on a benefit described in paragraph (1) or (2) of subdivision (a), or any other benefit described in subdivision (a) for which the Internal Revenue Service has indicated that the minimum deductible may be waived in a high deductible health plan.(e)(f) A health care service plan shall provide coverage for diabetes outpatient self-management training, education, and medical nutrition therapy necessary to enable an enrollee to properly use the equipment, supplies, and medications set forth in subdivisions (a) and (b), and additional diabetes outpatient self-management training, education, and medical nutrition therapy upon the direction or prescription of those services by the enrollees participating physician. If a plan delegates outpatient self-management training to contracting providers, the plan shall require contracting providers to ensure that diabetes outpatient self-management training, education, and medical nutrition therapy are provided by appropriately licensed or registered health care professionals.(f)(g) The diabetes outpatient self-management training, education, and medical nutrition therapy services identified in subdivision (e) (f) shall be provided by appropriately licensed or registered health care professionals as prescribed by a participating health care professional legally authorized to prescribe the service. These benefits shall include, but not be limited to, instruction that will enable diabetic patients and their families to gain an understanding of the diabetic disease process, and the daily management of diabetic therapy, in order to thereby avoid frequent hospitalizations and complications.(g)(h) The copayments for the benefits specified in subdivision (e) (f) shall not exceed those established for physician office visits by the plan.(h)(i) A health care service plan governed by this section shall disclose the benefits covered pursuant to this section in the plans evidence of coverage and disclosure contract forms.(i)(j) A health care service plan shall not reduce or eliminate coverage as a result of this section.(j)(k) This section does not deny or restrict the departments authority to ensure plan compliance with this chapter if a plan provides coverage for prescription drugs.
80+1367.51. (a) A health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2000, shall include coverage for the following equipment and supplies for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes as medically necessary, even if the items are available without a prescription:(1) Blood glucose monitors and blood glucose testing strips.(2) Blood glucose monitors designed to assist the visually impaired.(3) Insulin pumps and all related necessary supplies.(4) Ketone urine testing strips.(5) Lancets and lancet puncture devices.(6) Pen delivery systems for the administration of insulin.(7) Podiatric devices to prevent or treat diabetes-related complications.(8) Insulin syringes.(9) Visual aids, excluding eyewear, to assist the visually impaired with proper dosing of insulin.(b) A health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2000, that covers prescription benefits shall include coverage for the following prescription items if the items are determined to be medically necessary:(1) Insulin.(2) Prescriptive medications for the treatment of diabetes.(3) Glucagon.(c) The copayments and deductibles for the benefits specified in subdivisions (a) and (b) shall not exceed those established for similar benefits within the given plan.(d) (1) Notwithstanding subdivision (c), for a health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, the copayment for an insulin prescription covered pursuant to subdivision (b) shall not exceed thirty-five dollars ($35) per month per each dosage form of insulin products.(2) A health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible, coinsurance, or other cost-sharing requirement on an insulin prescription, except for a copayment subject to the limitations in paragraph (1).(3) Paragraphs (1) and (2) shall only apply to one of each dosage form and insulin type.(4) A health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible requirement on a benefit described in subdivision (a).(e) A health care service plan shall provide coverage for diabetes outpatient self-management training, education, and medical nutrition therapy necessary to enable an enrollee to properly use the equipment, supplies, and medications set forth in subdivisions (a) and (b), and additional diabetes outpatient self-management training, education, and medical nutrition therapy upon the direction or prescription of those services by the enrollees participating physician. If a plan delegates outpatient self-management training to contracting providers, the plan shall require contracting providers to ensure that diabetes outpatient self-management training, education, and medical nutrition therapy are provided by appropriately licensed or registered health care professionals.(f) The diabetes outpatient self-management training, education, and medical nutrition therapy services identified in subdivision (e) shall be provided by appropriately licensed or registered health care professionals as prescribed by a participating health care professional legally authorized to prescribe the service. These benefits shall include, but not be limited to, instruction that will enable diabetic patients and their families to gain an understanding of the diabetic disease process, and the daily management of diabetic therapy, in order to thereby avoid frequent hospitalizations and complications.(g) The copayments for the benefits specified in subdivision (e) shall not exceed those established for physician office visits by the plan.(h) A health care service plan governed by this section shall disclose the benefits covered pursuant to this section in the plans evidence of coverage and disclosure forms.(i) A health care service plan shall not reduce or eliminate coverage as a result of this section.(j) This section does not deny or restrict the departments authority to ensure plan compliance with this chapter if a plan provides coverage for prescription drugs.
8281
83-1367.51. (a) A health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2000, shall include coverage for the following equipment and supplies for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes as medically necessary, even if the items are available without a prescription:(1) Blood glucose monitors and blood glucose testing strips.(2) Blood glucose monitors designed to assist the visually impaired.(3) Insulin pumps and all related necessary supplies.(4) Ketone urine testing strips.(5) Lancets and lancet puncture devices.(6) Pen delivery systems for the administration of insulin.(7) Podiatric devices to prevent or treat diabetes-related complications.(8) Insulin syringes.(9) Visual aids, excluding eyewear, to assist the visually impaired with proper dosing of insulin.(b) A health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2000, that covers prescription drug benefits shall include coverage for the following prescription items if the items are determined to be medically necessary:(1) Insulin.(2) Prescriptive medications for the treatment of diabetes.(3) Glucagon.(c) The copayments and deductibles for the benefits specified in subdivisions (a) and (b) shall not exceed those established for similar benefits within the given plan.(d) (1) Notwithstanding subdivision (c), for a health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, the copayment for an insulin prescription covered pursuant to subdivision (b) shall not exceed thirty-five dollars ($35) per month per each dosage form of insulin products. shall cover all available dosage forms and concentrations of at least one insulin product of each insulin type for a copayment of no more than thirty-five dollars ($35) for a monthly supply. If a contract covers prescription drugs in larger amounts than a monthly supply, the copayment on that amount shall be equal to or less than the multiple of the monthly supply copayment, so that the respective copayment for a 60-day or 90-day supply shall not exceed seventy dollars ($70) or one hundred five dollars ($105).(2) A health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible, coinsurance, or other cost-sharing requirement on an insulin prescription, prescription covered pursuant to paragraph (1), except for a copayment subject to the limitations in paragraph (1).(3)Paragraphs (1) and (2) shall only apply to one of each dosage form and insulin type.(3) For purposes of this subdivision:(A) Dosage form means the form in which insulin is packaged, including vial and pen delivery device.(B) Insulin type means rapid-acting, short-acting, intermediate-acting, or long-acting insulin.(4)(e) A health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible requirement on a benefit described in subdivision (a). If a health care service plan contract is a high deductible health plan, as defined in Section 223(c)(2) of Title 26 of the United States Code, the contract shall not impose a deductible requirement on a benefit described in paragraph (1) or (2) of subdivision (a), or any other benefit described in subdivision (a) for which the Internal Revenue Service has indicated that the minimum deductible may be waived in a high deductible health plan.(e)(f) A health care service plan shall provide coverage for diabetes outpatient self-management training, education, and medical nutrition therapy necessary to enable an enrollee to properly use the equipment, supplies, and medications set forth in subdivisions (a) and (b), and additional diabetes outpatient self-management training, education, and medical nutrition therapy upon the direction or prescription of those services by the enrollees participating physician. If a plan delegates outpatient self-management training to contracting providers, the plan shall require contracting providers to ensure that diabetes outpatient self-management training, education, and medical nutrition therapy are provided by appropriately licensed or registered health care professionals.(f)(g) The diabetes outpatient self-management training, education, and medical nutrition therapy services identified in subdivision (e) (f) shall be provided by appropriately licensed or registered health care professionals as prescribed by a participating health care professional legally authorized to prescribe the service. These benefits shall include, but not be limited to, instruction that will enable diabetic patients and their families to gain an understanding of the diabetic disease process, and the daily management of diabetic therapy, in order to thereby avoid frequent hospitalizations and complications.(g)(h) The copayments for the benefits specified in subdivision (e) (f) shall not exceed those established for physician office visits by the plan.(h)(i) A health care service plan governed by this section shall disclose the benefits covered pursuant to this section in the plans evidence of coverage and disclosure contract forms.(i)(j) A health care service plan shall not reduce or eliminate coverage as a result of this section.(j)(k) This section does not deny or restrict the departments authority to ensure plan compliance with this chapter if a plan provides coverage for prescription drugs.
82+1367.51. (a) A health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2000, shall include coverage for the following equipment and supplies for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes as medically necessary, even if the items are available without a prescription:(1) Blood glucose monitors and blood glucose testing strips.(2) Blood glucose monitors designed to assist the visually impaired.(3) Insulin pumps and all related necessary supplies.(4) Ketone urine testing strips.(5) Lancets and lancet puncture devices.(6) Pen delivery systems for the administration of insulin.(7) Podiatric devices to prevent or treat diabetes-related complications.(8) Insulin syringes.(9) Visual aids, excluding eyewear, to assist the visually impaired with proper dosing of insulin.(b) A health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2000, that covers prescription benefits shall include coverage for the following prescription items if the items are determined to be medically necessary:(1) Insulin.(2) Prescriptive medications for the treatment of diabetes.(3) Glucagon.(c) The copayments and deductibles for the benefits specified in subdivisions (a) and (b) shall not exceed those established for similar benefits within the given plan.(d) (1) Notwithstanding subdivision (c), for a health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, the copayment for an insulin prescription covered pursuant to subdivision (b) shall not exceed thirty-five dollars ($35) per month per each dosage form of insulin products.(2) A health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible, coinsurance, or other cost-sharing requirement on an insulin prescription, except for a copayment subject to the limitations in paragraph (1).(3) Paragraphs (1) and (2) shall only apply to one of each dosage form and insulin type.(4) A health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible requirement on a benefit described in subdivision (a).(e) A health care service plan shall provide coverage for diabetes outpatient self-management training, education, and medical nutrition therapy necessary to enable an enrollee to properly use the equipment, supplies, and medications set forth in subdivisions (a) and (b), and additional diabetes outpatient self-management training, education, and medical nutrition therapy upon the direction or prescription of those services by the enrollees participating physician. If a plan delegates outpatient self-management training to contracting providers, the plan shall require contracting providers to ensure that diabetes outpatient self-management training, education, and medical nutrition therapy are provided by appropriately licensed or registered health care professionals.(f) The diabetes outpatient self-management training, education, and medical nutrition therapy services identified in subdivision (e) shall be provided by appropriately licensed or registered health care professionals as prescribed by a participating health care professional legally authorized to prescribe the service. These benefits shall include, but not be limited to, instruction that will enable diabetic patients and their families to gain an understanding of the diabetic disease process, and the daily management of diabetic therapy, in order to thereby avoid frequent hospitalizations and complications.(g) The copayments for the benefits specified in subdivision (e) shall not exceed those established for physician office visits by the plan.(h) A health care service plan governed by this section shall disclose the benefits covered pursuant to this section in the plans evidence of coverage and disclosure forms.(i) A health care service plan shall not reduce or eliminate coverage as a result of this section.(j) This section does not deny or restrict the departments authority to ensure plan compliance with this chapter if a plan provides coverage for prescription drugs.
8483
8584
8685
8786 1367.51. (a) A health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2000, shall include coverage for the following equipment and supplies for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes as medically necessary, even if the items are available without a prescription:
8887
8988 (1) Blood glucose monitors and blood glucose testing strips.
9089
9190 (2) Blood glucose monitors designed to assist the visually impaired.
9291
9392 (3) Insulin pumps and all related necessary supplies.
9493
9594 (4) Ketone urine testing strips.
9695
9796 (5) Lancets and lancet puncture devices.
9897
9998 (6) Pen delivery systems for the administration of insulin.
10099
101100 (7) Podiatric devices to prevent or treat diabetes-related complications.
102101
103102 (8) Insulin syringes.
104103
105104 (9) Visual aids, excluding eyewear, to assist the visually impaired with proper dosing of insulin.
106105
107-(b) A health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2000, that covers prescription drug benefits shall include coverage for the following prescription items if the items are determined to be medically necessary:
106+(b) A health care service plan contract, except a specialized health care service plan contract, that is issued, amended, delivered, or renewed on or after January 1, 2000, that covers prescription benefits shall include coverage for the following prescription items if the items are determined to be medically necessary:
108107
109108 (1) Insulin.
110109
111110 (2) Prescriptive medications for the treatment of diabetes.
112111
113112 (3) Glucagon.
114113
115114 (c) The copayments and deductibles for the benefits specified in subdivisions (a) and (b) shall not exceed those established for similar benefits within the given plan.
116115
117-(d) (1) Notwithstanding subdivision (c), for a health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, the copayment for an insulin prescription covered pursuant to subdivision (b) shall not exceed thirty-five dollars ($35) per month per each dosage form of insulin products. shall cover all available dosage forms and concentrations of at least one insulin product of each insulin type for a copayment of no more than thirty-five dollars ($35) for a monthly supply. If a contract covers prescription drugs in larger amounts than a monthly supply, the copayment on that amount shall be equal to or less than the multiple of the monthly supply copayment, so that the respective copayment for a 60-day or 90-day supply shall not exceed seventy dollars ($70) or one hundred five dollars ($105).
116+(d) (1) Notwithstanding subdivision (c), for a health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, the copayment for an insulin prescription covered pursuant to subdivision (b) shall not exceed thirty-five dollars ($35) per month per each dosage form of insulin products.
118117
119-(2) A health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible, coinsurance, or other cost-sharing requirement on an insulin prescription, prescription covered pursuant to paragraph (1), except for a copayment subject to the limitations in paragraph (1).
118+(2) A health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible, coinsurance, or other cost-sharing requirement on an insulin prescription, except for a copayment subject to the limitations in paragraph (1).
120119
121120 (3) Paragraphs (1) and (2) shall only apply to one of each dosage form and insulin type.
122121
122+(4) A health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible requirement on a benefit described in subdivision (a).
123123
124+(e) A health care service plan shall provide coverage for diabetes outpatient self-management training, education, and medical nutrition therapy necessary to enable an enrollee to properly use the equipment, supplies, and medications set forth in subdivisions (a) and (b), and additional diabetes outpatient self-management training, education, and medical nutrition therapy upon the direction or prescription of those services by the enrollees participating physician. If a plan delegates outpatient self-management training to contracting providers, the plan shall require contracting providers to ensure that diabetes outpatient self-management training, education, and medical nutrition therapy are provided by appropriately licensed or registered health care professionals.
124125
125-(3) For purposes of this subdivision:
126+(f) The diabetes outpatient self-management training, education, and medical nutrition therapy services identified in subdivision (e) shall be provided by appropriately licensed or registered health care professionals as prescribed by a participating health care professional legally authorized to prescribe the service. These benefits shall include, but not be limited to, instruction that will enable diabetic patients and their families to gain an understanding of the diabetic disease process, and the daily management of diabetic therapy, in order to thereby avoid frequent hospitalizations and complications.
126127
127-(A) Dosage form means the form in which insulin is packaged, including vial and pen delivery device.
128+(g) The copayments for the benefits specified in subdivision (e) shall not exceed those established for physician office visits by the plan.
128129
129-(B) Insulin type means rapid-acting, short-acting, intermediate-acting, or long-acting insulin.
130+(h) A health care service plan governed by this section shall disclose the benefits covered pursuant to this section in the plans evidence of coverage and disclosure forms.
130131
131-(4)
132+(i) A health care service plan shall not reduce or eliminate coverage as a result of this section.
132133
134+(j) This section does not deny or restrict the departments authority to ensure plan compliance with this chapter if a plan provides coverage for prescription drugs.
133135
134-
135-(e) A health care service plan contract that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible requirement on a benefit described in subdivision (a). If a health care service plan contract is a high deductible health plan, as defined in Section 223(c)(2) of Title 26 of the United States Code, the contract shall not impose a deductible requirement on a benefit described in paragraph (1) or (2) of subdivision (a), or any other benefit described in subdivision (a) for which the Internal Revenue Service has indicated that the minimum deductible may be waived in a high deductible health plan.
136-
137-(e)
138-
139-
140-
141-(f) A health care service plan shall provide coverage for diabetes outpatient self-management training, education, and medical nutrition therapy necessary to enable an enrollee to properly use the equipment, supplies, and medications set forth in subdivisions (a) and (b), and additional diabetes outpatient self-management training, education, and medical nutrition therapy upon the direction or prescription of those services by the enrollees participating physician. If a plan delegates outpatient self-management training to contracting providers, the plan shall require contracting providers to ensure that diabetes outpatient self-management training, education, and medical nutrition therapy are provided by appropriately licensed or registered health care professionals.
142-
143-(f)
144-
145-
146-
147-(g) The diabetes outpatient self-management training, education, and medical nutrition therapy services identified in subdivision (e) (f) shall be provided by appropriately licensed or registered health care professionals as prescribed by a participating health care professional legally authorized to prescribe the service. These benefits shall include, but not be limited to, instruction that will enable diabetic patients and their families to gain an understanding of the diabetic disease process, and the daily management of diabetic therapy, in order to thereby avoid frequent hospitalizations and complications.
148-
149-(g)
150-
151-
152-
153-(h) The copayments for the benefits specified in subdivision (e) (f) shall not exceed those established for physician office visits by the plan.
154-
155-(h)
156-
157-
158-
159-(i) A health care service plan governed by this section shall disclose the benefits covered pursuant to this section in the plans evidence of coverage and disclosure contract forms.
160-
161-(i)
162-
163-
164-
165-(j) A health care service plan shall not reduce or eliminate coverage as a result of this section.
166-
167-(j)
168-
169-
170-
171-(k) This section does not deny or restrict the departments authority to ensure plan compliance with this chapter if a plan provides coverage for prescription drugs.
172-
173-SEC. 3. Section 10176.61 of the Insurance Code is amended to read:10176.61. (a) A health insurance policy issued, amended, or renewed on or after January 1, 2000, shall include coverage for the following equipment and supplies for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes as medically necessary, even if the items are available without a prescription:(1) Blood glucose monitors and blood glucose testing strips.(2) Blood glucose monitors designed to assist the visually impaired.(3) Insulin pumps and all related necessary supplies.(4) Ketone urine testing strips.(5) Lancets and lancet puncture devices.(6) Pen delivery systems for the administration of insulin.(7) Podiatric devices to prevent or treat diabetes-related complications.(8) Insulin syringes.(9) Visual aids, excluding eyewear, to assist the visually impaired with proper dosing of insulin.(b) A health insurance policy that is issued, amended, or renewed on or after January 1, 2000, that covers prescription drug benefits shall include coverage for the following prescription items if the items are determined to be medically necessary:(1) Insulin.(2) Prescriptive medications for the treatment of diabetes.(3) Glucagon.(c) The coinsurances and deductibles for the benefits specified in subdivisions (a) and (b) shall not exceed those established for similar benefits within the given policy.(d) (1) Notwithstanding subdivision (c), for a health insurance policy that is issued, amended, or renewed on or after January 1, 2023, the copayment for an insulin prescription covered pursuant to subdivision (b) shall not exceed thirty-five dollars ($35) per month per each dosage form of insulin products. shall cover all available dosage forms and concentrations of at least one insulin product of each insulin type for a copayment of no more than thirty-five dollars ($35) for a monthly supply. If a policy covers prescription drugs in larger amounts than a monthly supply, the copayment on that amount shall be equal to or less than the multiple of the monthly supply copayment, so that the respective copayment for a 60-day or 90-day supply shall not exceed seventy dollars ($70) or one hundred five dollars ($105).(2) A health insurance policy that is issued, amended, or renewed on or after January 1, 2023, shall not impose a deductible, coinsurance, or other cost-sharing requirement on an insulin prescription, prescription covered pursuant to paragraph (1), except for a copayment subject to the limitations in paragraph (1).(3)Paragraphs (1) and (2) shall only apply to one of each dosage form and insulin type.(3) For purposes of this subdivision:(A) Dosage form means the form in which insulin is packaged, including vial and pen delivery device.(B) Insulin type means rapid-acting, short-acting, intermediate-acting, or long-acting insulin.(4)(e) A health insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible requirement on a benefit described in subdivision (a). If a health insurance policy is a high deductible health plan, as defined in Section 223(c)(2) of Title 26 of the United States Code, the policy shall not impose a deductible requirement on a benefit described in paragraph (1) or (2) of subdivision (a), or any other benefit described in subdivision (a) for which the Internal Revenue Service has indicated that the minimum deductible may be waived in a high deductible health plan.(e)(f) A health insurer shall provide coverage for diabetes outpatient self-management training, education, and medical nutrition therapy necessary to enable an insured to properly use the equipment, supplies, and medications set forth in subdivisions (a) and (b) and additional diabetes outpatient self-management training, education, and medical nutrition therapy upon the direction or prescription of those services by the insureds participating physician. If an insurer delegates outpatient self-management training to contracting providers, the insurer shall require contracting providers to ensure that diabetes outpatient self-management training, education, and medical nutrition therapy are provided by appropriately licensed or registered health care professionals.(f)(g) The diabetes outpatient self-management training, education, and medical nutrition therapy services identified in subdivision (e) (f) shall be provided by appropriately licensed or registered health care professionals as prescribed by a health care professional legally authorized to prescribe the services.(g)(h) The coinsurances and deductibles for the benefits specified in subdivision (e) (f) shall not exceed those established for physician office visits by the insurer.(h)(i) A health insurer governed by this section shall disclose the benefits covered pursuant to this section in the insurers evidence of coverage and disclosure policy forms.(i)(j) A health insurer shall not reduce or eliminate coverage as a result of this section.(j)(k) This section does not apply to vision-only, dental-only, accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, or disability income insurance, except that for accident-only, specified disease, and hospital indemnity insurance coverage, benefits under this section only apply to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy. This section does not impose a new benefit mandate on accident-only, specified disease, or hospital indemnity insurance.
136+SEC. 3. Section 10176.61 of the Insurance Code is amended to read:10176.61. (a) A health insurance policy issued, amended, or renewed on or after January 1, 2000, shall include coverage for the following equipment and supplies for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes as medically necessary, even if the items are available without a prescription:(1) Blood glucose monitors and blood glucose testing strips.(2) Blood glucose monitors designed to assist the visually impaired.(3) Insulin pumps and all related necessary supplies.(4) Ketone urine testing strips.(5) Lancets and lancet puncture devices.(6) Pen delivery systems for the administration of insulin.(7) Podiatric devices to prevent or treat diabetes-related complications.(8) Insulin syringes.(9) Visual aids, excluding eyewear, to assist the visually impaired with proper dosing of insulin.(b) A health insurance policy that is issued, amended, or renewed on or after January 1, 2000, that covers prescription benefits shall include coverage for the following prescription items if the items are determined to be medically necessary:(1) Insulin.(2) Prescriptive medications for the treatment of diabetes.(3) Glucagon.(c) The coinsurances and deductibles for the benefits specified in subdivisions (a) and (b) shall not exceed those established for similar benefits within the given policy.(d) (1) Notwithstanding subdivision (c), for a health insurance policy that is issued, amended, or renewed on or after January 1, 2023, the copayment for an insulin prescription covered pursuant to subdivision (b) shall not exceed thirty-five dollars ($35) per month per each dosage form of insulin products.(2) A health insurance policy that is issued, amended, or renewed on or after January 1, 2023, shall not impose a deductible, coinsurance, or other cost-sharing requirement on an insulin prescription, except for a copayment subject to the limitations in paragraph (1).(3) Paragraphs (1) and (2) shall only apply to one of each dosage form and insulin type.(4) A health insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible requirement on a benefit described in subdivision (a).(e) A health insurer shall provide coverage for diabetes outpatient self-management training, education, and medical nutrition therapy necessary to enable an insured to properly use the equipment, supplies, and medications set forth in subdivisions (a) and (b) and additional diabetes outpatient self-management training, education, and medical nutrition therapy upon the direction or prescription of those services by the insureds participating physician. If an insurer delegates outpatient self-management training to contracting providers, the insurer shall require contracting providers to ensure that diabetes outpatient self-management training, education, and medical nutrition therapy are provided by appropriately licensed or registered health care professionals.(f) The diabetes outpatient self-management training, education, and medical nutrition therapy services identified in subdivision (e) shall be provided by appropriately licensed or registered health care professionals as prescribed by a health care professional legally authorized to prescribe the services.(g) The coinsurances and deductibles for the benefits specified in subdivision (e) shall not exceed those established for physician office visits by the insurer.(h) A health insurer governed by this section shall disclose the benefits covered pursuant to this section in the insurers evidence of coverage and disclosure forms.(i) A health insurer shall not reduce or eliminate coverage as a result of this section.(j) This section does not apply to vision-only, dental-only, accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, or disability income insurance, except that for accident-only, specified disease, and hospital indemnity insurance coverage, benefits under this section only apply to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy. This section does not impose a new benefit mandate on accident-only, specified disease, or hospital indemnity insurance.
174137
175138 SEC. 3. Section 10176.61 of the Insurance Code is amended to read:
176139
177140 ### SEC. 3.
178141
179-10176.61. (a) A health insurance policy issued, amended, or renewed on or after January 1, 2000, shall include coverage for the following equipment and supplies for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes as medically necessary, even if the items are available without a prescription:(1) Blood glucose monitors and blood glucose testing strips.(2) Blood glucose monitors designed to assist the visually impaired.(3) Insulin pumps and all related necessary supplies.(4) Ketone urine testing strips.(5) Lancets and lancet puncture devices.(6) Pen delivery systems for the administration of insulin.(7) Podiatric devices to prevent or treat diabetes-related complications.(8) Insulin syringes.(9) Visual aids, excluding eyewear, to assist the visually impaired with proper dosing of insulin.(b) A health insurance policy that is issued, amended, or renewed on or after January 1, 2000, that covers prescription drug benefits shall include coverage for the following prescription items if the items are determined to be medically necessary:(1) Insulin.(2) Prescriptive medications for the treatment of diabetes.(3) Glucagon.(c) The coinsurances and deductibles for the benefits specified in subdivisions (a) and (b) shall not exceed those established for similar benefits within the given policy.(d) (1) Notwithstanding subdivision (c), for a health insurance policy that is issued, amended, or renewed on or after January 1, 2023, the copayment for an insulin prescription covered pursuant to subdivision (b) shall not exceed thirty-five dollars ($35) per month per each dosage form of insulin products. shall cover all available dosage forms and concentrations of at least one insulin product of each insulin type for a copayment of no more than thirty-five dollars ($35) for a monthly supply. If a policy covers prescription drugs in larger amounts than a monthly supply, the copayment on that amount shall be equal to or less than the multiple of the monthly supply copayment, so that the respective copayment for a 60-day or 90-day supply shall not exceed seventy dollars ($70) or one hundred five dollars ($105).(2) A health insurance policy that is issued, amended, or renewed on or after January 1, 2023, shall not impose a deductible, coinsurance, or other cost-sharing requirement on an insulin prescription, prescription covered pursuant to paragraph (1), except for a copayment subject to the limitations in paragraph (1).(3)Paragraphs (1) and (2) shall only apply to one of each dosage form and insulin type.(3) For purposes of this subdivision:(A) Dosage form means the form in which insulin is packaged, including vial and pen delivery device.(B) Insulin type means rapid-acting, short-acting, intermediate-acting, or long-acting insulin.(4)(e) A health insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible requirement on a benefit described in subdivision (a). If a health insurance policy is a high deductible health plan, as defined in Section 223(c)(2) of Title 26 of the United States Code, the policy shall not impose a deductible requirement on a benefit described in paragraph (1) or (2) of subdivision (a), or any other benefit described in subdivision (a) for which the Internal Revenue Service has indicated that the minimum deductible may be waived in a high deductible health plan.(e)(f) A health insurer shall provide coverage for diabetes outpatient self-management training, education, and medical nutrition therapy necessary to enable an insured to properly use the equipment, supplies, and medications set forth in subdivisions (a) and (b) and additional diabetes outpatient self-management training, education, and medical nutrition therapy upon the direction or prescription of those services by the insureds participating physician. If an insurer delegates outpatient self-management training to contracting providers, the insurer shall require contracting providers to ensure that diabetes outpatient self-management training, education, and medical nutrition therapy are provided by appropriately licensed or registered health care professionals.(f)(g) The diabetes outpatient self-management training, education, and medical nutrition therapy services identified in subdivision (e) (f) shall be provided by appropriately licensed or registered health care professionals as prescribed by a health care professional legally authorized to prescribe the services.(g)(h) The coinsurances and deductibles for the benefits specified in subdivision (e) (f) shall not exceed those established for physician office visits by the insurer.(h)(i) A health insurer governed by this section shall disclose the benefits covered pursuant to this section in the insurers evidence of coverage and disclosure policy forms.(i)(j) A health insurer shall not reduce or eliminate coverage as a result of this section.(j)(k) This section does not apply to vision-only, dental-only, accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, or disability income insurance, except that for accident-only, specified disease, and hospital indemnity insurance coverage, benefits under this section only apply to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy. This section does not impose a new benefit mandate on accident-only, specified disease, or hospital indemnity insurance.
142+10176.61. (a) A health insurance policy issued, amended, or renewed on or after January 1, 2000, shall include coverage for the following equipment and supplies for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes as medically necessary, even if the items are available without a prescription:(1) Blood glucose monitors and blood glucose testing strips.(2) Blood glucose monitors designed to assist the visually impaired.(3) Insulin pumps and all related necessary supplies.(4) Ketone urine testing strips.(5) Lancets and lancet puncture devices.(6) Pen delivery systems for the administration of insulin.(7) Podiatric devices to prevent or treat diabetes-related complications.(8) Insulin syringes.(9) Visual aids, excluding eyewear, to assist the visually impaired with proper dosing of insulin.(b) A health insurance policy that is issued, amended, or renewed on or after January 1, 2000, that covers prescription benefits shall include coverage for the following prescription items if the items are determined to be medically necessary:(1) Insulin.(2) Prescriptive medications for the treatment of diabetes.(3) Glucagon.(c) The coinsurances and deductibles for the benefits specified in subdivisions (a) and (b) shall not exceed those established for similar benefits within the given policy.(d) (1) Notwithstanding subdivision (c), for a health insurance policy that is issued, amended, or renewed on or after January 1, 2023, the copayment for an insulin prescription covered pursuant to subdivision (b) shall not exceed thirty-five dollars ($35) per month per each dosage form of insulin products.(2) A health insurance policy that is issued, amended, or renewed on or after January 1, 2023, shall not impose a deductible, coinsurance, or other cost-sharing requirement on an insulin prescription, except for a copayment subject to the limitations in paragraph (1).(3) Paragraphs (1) and (2) shall only apply to one of each dosage form and insulin type.(4) A health insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible requirement on a benefit described in subdivision (a).(e) A health insurer shall provide coverage for diabetes outpatient self-management training, education, and medical nutrition therapy necessary to enable an insured to properly use the equipment, supplies, and medications set forth in subdivisions (a) and (b) and additional diabetes outpatient self-management training, education, and medical nutrition therapy upon the direction or prescription of those services by the insureds participating physician. If an insurer delegates outpatient self-management training to contracting providers, the insurer shall require contracting providers to ensure that diabetes outpatient self-management training, education, and medical nutrition therapy are provided by appropriately licensed or registered health care professionals.(f) The diabetes outpatient self-management training, education, and medical nutrition therapy services identified in subdivision (e) shall be provided by appropriately licensed or registered health care professionals as prescribed by a health care professional legally authorized to prescribe the services.(g) The coinsurances and deductibles for the benefits specified in subdivision (e) shall not exceed those established for physician office visits by the insurer.(h) A health insurer governed by this section shall disclose the benefits covered pursuant to this section in the insurers evidence of coverage and disclosure forms.(i) A health insurer shall not reduce or eliminate coverage as a result of this section.(j) This section does not apply to vision-only, dental-only, accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, or disability income insurance, except that for accident-only, specified disease, and hospital indemnity insurance coverage, benefits under this section only apply to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy. This section does not impose a new benefit mandate on accident-only, specified disease, or hospital indemnity insurance.
180143
181-10176.61. (a) A health insurance policy issued, amended, or renewed on or after January 1, 2000, shall include coverage for the following equipment and supplies for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes as medically necessary, even if the items are available without a prescription:(1) Blood glucose monitors and blood glucose testing strips.(2) Blood glucose monitors designed to assist the visually impaired.(3) Insulin pumps and all related necessary supplies.(4) Ketone urine testing strips.(5) Lancets and lancet puncture devices.(6) Pen delivery systems for the administration of insulin.(7) Podiatric devices to prevent or treat diabetes-related complications.(8) Insulin syringes.(9) Visual aids, excluding eyewear, to assist the visually impaired with proper dosing of insulin.(b) A health insurance policy that is issued, amended, or renewed on or after January 1, 2000, that covers prescription drug benefits shall include coverage for the following prescription items if the items are determined to be medically necessary:(1) Insulin.(2) Prescriptive medications for the treatment of diabetes.(3) Glucagon.(c) The coinsurances and deductibles for the benefits specified in subdivisions (a) and (b) shall not exceed those established for similar benefits within the given policy.(d) (1) Notwithstanding subdivision (c), for a health insurance policy that is issued, amended, or renewed on or after January 1, 2023, the copayment for an insulin prescription covered pursuant to subdivision (b) shall not exceed thirty-five dollars ($35) per month per each dosage form of insulin products. shall cover all available dosage forms and concentrations of at least one insulin product of each insulin type for a copayment of no more than thirty-five dollars ($35) for a monthly supply. If a policy covers prescription drugs in larger amounts than a monthly supply, the copayment on that amount shall be equal to or less than the multiple of the monthly supply copayment, so that the respective copayment for a 60-day or 90-day supply shall not exceed seventy dollars ($70) or one hundred five dollars ($105).(2) A health insurance policy that is issued, amended, or renewed on or after January 1, 2023, shall not impose a deductible, coinsurance, or other cost-sharing requirement on an insulin prescription, prescription covered pursuant to paragraph (1), except for a copayment subject to the limitations in paragraph (1).(3)Paragraphs (1) and (2) shall only apply to one of each dosage form and insulin type.(3) For purposes of this subdivision:(A) Dosage form means the form in which insulin is packaged, including vial and pen delivery device.(B) Insulin type means rapid-acting, short-acting, intermediate-acting, or long-acting insulin.(4)(e) A health insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible requirement on a benefit described in subdivision (a). If a health insurance policy is a high deductible health plan, as defined in Section 223(c)(2) of Title 26 of the United States Code, the policy shall not impose a deductible requirement on a benefit described in paragraph (1) or (2) of subdivision (a), or any other benefit described in subdivision (a) for which the Internal Revenue Service has indicated that the minimum deductible may be waived in a high deductible health plan.(e)(f) A health insurer shall provide coverage for diabetes outpatient self-management training, education, and medical nutrition therapy necessary to enable an insured to properly use the equipment, supplies, and medications set forth in subdivisions (a) and (b) and additional diabetes outpatient self-management training, education, and medical nutrition therapy upon the direction or prescription of those services by the insureds participating physician. If an insurer delegates outpatient self-management training to contracting providers, the insurer shall require contracting providers to ensure that diabetes outpatient self-management training, education, and medical nutrition therapy are provided by appropriately licensed or registered health care professionals.(f)(g) The diabetes outpatient self-management training, education, and medical nutrition therapy services identified in subdivision (e) (f) shall be provided by appropriately licensed or registered health care professionals as prescribed by a health care professional legally authorized to prescribe the services.(g)(h) The coinsurances and deductibles for the benefits specified in subdivision (e) (f) shall not exceed those established for physician office visits by the insurer.(h)(i) A health insurer governed by this section shall disclose the benefits covered pursuant to this section in the insurers evidence of coverage and disclosure policy forms.(i)(j) A health insurer shall not reduce or eliminate coverage as a result of this section.(j)(k) This section does not apply to vision-only, dental-only, accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, or disability income insurance, except that for accident-only, specified disease, and hospital indemnity insurance coverage, benefits under this section only apply to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy. This section does not impose a new benefit mandate on accident-only, specified disease, or hospital indemnity insurance.
144+10176.61. (a) A health insurance policy issued, amended, or renewed on or after January 1, 2000, shall include coverage for the following equipment and supplies for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes as medically necessary, even if the items are available without a prescription:(1) Blood glucose monitors and blood glucose testing strips.(2) Blood glucose monitors designed to assist the visually impaired.(3) Insulin pumps and all related necessary supplies.(4) Ketone urine testing strips.(5) Lancets and lancet puncture devices.(6) Pen delivery systems for the administration of insulin.(7) Podiatric devices to prevent or treat diabetes-related complications.(8) Insulin syringes.(9) Visual aids, excluding eyewear, to assist the visually impaired with proper dosing of insulin.(b) A health insurance policy that is issued, amended, or renewed on or after January 1, 2000, that covers prescription benefits shall include coverage for the following prescription items if the items are determined to be medically necessary:(1) Insulin.(2) Prescriptive medications for the treatment of diabetes.(3) Glucagon.(c) The coinsurances and deductibles for the benefits specified in subdivisions (a) and (b) shall not exceed those established for similar benefits within the given policy.(d) (1) Notwithstanding subdivision (c), for a health insurance policy that is issued, amended, or renewed on or after January 1, 2023, the copayment for an insulin prescription covered pursuant to subdivision (b) shall not exceed thirty-five dollars ($35) per month per each dosage form of insulin products.(2) A health insurance policy that is issued, amended, or renewed on or after January 1, 2023, shall not impose a deductible, coinsurance, or other cost-sharing requirement on an insulin prescription, except for a copayment subject to the limitations in paragraph (1).(3) Paragraphs (1) and (2) shall only apply to one of each dosage form and insulin type.(4) A health insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible requirement on a benefit described in subdivision (a).(e) A health insurer shall provide coverage for diabetes outpatient self-management training, education, and medical nutrition therapy necessary to enable an insured to properly use the equipment, supplies, and medications set forth in subdivisions (a) and (b) and additional diabetes outpatient self-management training, education, and medical nutrition therapy upon the direction or prescription of those services by the insureds participating physician. If an insurer delegates outpatient self-management training to contracting providers, the insurer shall require contracting providers to ensure that diabetes outpatient self-management training, education, and medical nutrition therapy are provided by appropriately licensed or registered health care professionals.(f) The diabetes outpatient self-management training, education, and medical nutrition therapy services identified in subdivision (e) shall be provided by appropriately licensed or registered health care professionals as prescribed by a health care professional legally authorized to prescribe the services.(g) The coinsurances and deductibles for the benefits specified in subdivision (e) shall not exceed those established for physician office visits by the insurer.(h) A health insurer governed by this section shall disclose the benefits covered pursuant to this section in the insurers evidence of coverage and disclosure forms.(i) A health insurer shall not reduce or eliminate coverage as a result of this section.(j) This section does not apply to vision-only, dental-only, accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, or disability income insurance, except that for accident-only, specified disease, and hospital indemnity insurance coverage, benefits under this section only apply to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy. This section does not impose a new benefit mandate on accident-only, specified disease, or hospital indemnity insurance.
182145
183-10176.61. (a) A health insurance policy issued, amended, or renewed on or after January 1, 2000, shall include coverage for the following equipment and supplies for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes as medically necessary, even if the items are available without a prescription:(1) Blood glucose monitors and blood glucose testing strips.(2) Blood glucose monitors designed to assist the visually impaired.(3) Insulin pumps and all related necessary supplies.(4) Ketone urine testing strips.(5) Lancets and lancet puncture devices.(6) Pen delivery systems for the administration of insulin.(7) Podiatric devices to prevent or treat diabetes-related complications.(8) Insulin syringes.(9) Visual aids, excluding eyewear, to assist the visually impaired with proper dosing of insulin.(b) A health insurance policy that is issued, amended, or renewed on or after January 1, 2000, that covers prescription drug benefits shall include coverage for the following prescription items if the items are determined to be medically necessary:(1) Insulin.(2) Prescriptive medications for the treatment of diabetes.(3) Glucagon.(c) The coinsurances and deductibles for the benefits specified in subdivisions (a) and (b) shall not exceed those established for similar benefits within the given policy.(d) (1) Notwithstanding subdivision (c), for a health insurance policy that is issued, amended, or renewed on or after January 1, 2023, the copayment for an insulin prescription covered pursuant to subdivision (b) shall not exceed thirty-five dollars ($35) per month per each dosage form of insulin products. shall cover all available dosage forms and concentrations of at least one insulin product of each insulin type for a copayment of no more than thirty-five dollars ($35) for a monthly supply. If a policy covers prescription drugs in larger amounts than a monthly supply, the copayment on that amount shall be equal to or less than the multiple of the monthly supply copayment, so that the respective copayment for a 60-day or 90-day supply shall not exceed seventy dollars ($70) or one hundred five dollars ($105).(2) A health insurance policy that is issued, amended, or renewed on or after January 1, 2023, shall not impose a deductible, coinsurance, or other cost-sharing requirement on an insulin prescription, prescription covered pursuant to paragraph (1), except for a copayment subject to the limitations in paragraph (1).(3)Paragraphs (1) and (2) shall only apply to one of each dosage form and insulin type.(3) For purposes of this subdivision:(A) Dosage form means the form in which insulin is packaged, including vial and pen delivery device.(B) Insulin type means rapid-acting, short-acting, intermediate-acting, or long-acting insulin.(4)(e) A health insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible requirement on a benefit described in subdivision (a). If a health insurance policy is a high deductible health plan, as defined in Section 223(c)(2) of Title 26 of the United States Code, the policy shall not impose a deductible requirement on a benefit described in paragraph (1) or (2) of subdivision (a), or any other benefit described in subdivision (a) for which the Internal Revenue Service has indicated that the minimum deductible may be waived in a high deductible health plan.(e)(f) A health insurer shall provide coverage for diabetes outpatient self-management training, education, and medical nutrition therapy necessary to enable an insured to properly use the equipment, supplies, and medications set forth in subdivisions (a) and (b) and additional diabetes outpatient self-management training, education, and medical nutrition therapy upon the direction or prescription of those services by the insureds participating physician. If an insurer delegates outpatient self-management training to contracting providers, the insurer shall require contracting providers to ensure that diabetes outpatient self-management training, education, and medical nutrition therapy are provided by appropriately licensed or registered health care professionals.(f)(g) The diabetes outpatient self-management training, education, and medical nutrition therapy services identified in subdivision (e) (f) shall be provided by appropriately licensed or registered health care professionals as prescribed by a health care professional legally authorized to prescribe the services.(g)(h) The coinsurances and deductibles for the benefits specified in subdivision (e) (f) shall not exceed those established for physician office visits by the insurer.(h)(i) A health insurer governed by this section shall disclose the benefits covered pursuant to this section in the insurers evidence of coverage and disclosure policy forms.(i)(j) A health insurer shall not reduce or eliminate coverage as a result of this section.(j)(k) This section does not apply to vision-only, dental-only, accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, or disability income insurance, except that for accident-only, specified disease, and hospital indemnity insurance coverage, benefits under this section only apply to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy. This section does not impose a new benefit mandate on accident-only, specified disease, or hospital indemnity insurance.
146+10176.61. (a) A health insurance policy issued, amended, or renewed on or after January 1, 2000, shall include coverage for the following equipment and supplies for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes as medically necessary, even if the items are available without a prescription:(1) Blood glucose monitors and blood glucose testing strips.(2) Blood glucose monitors designed to assist the visually impaired.(3) Insulin pumps and all related necessary supplies.(4) Ketone urine testing strips.(5) Lancets and lancet puncture devices.(6) Pen delivery systems for the administration of insulin.(7) Podiatric devices to prevent or treat diabetes-related complications.(8) Insulin syringes.(9) Visual aids, excluding eyewear, to assist the visually impaired with proper dosing of insulin.(b) A health insurance policy that is issued, amended, or renewed on or after January 1, 2000, that covers prescription benefits shall include coverage for the following prescription items if the items are determined to be medically necessary:(1) Insulin.(2) Prescriptive medications for the treatment of diabetes.(3) Glucagon.(c) The coinsurances and deductibles for the benefits specified in subdivisions (a) and (b) shall not exceed those established for similar benefits within the given policy.(d) (1) Notwithstanding subdivision (c), for a health insurance policy that is issued, amended, or renewed on or after January 1, 2023, the copayment for an insulin prescription covered pursuant to subdivision (b) shall not exceed thirty-five dollars ($35) per month per each dosage form of insulin products.(2) A health insurance policy that is issued, amended, or renewed on or after January 1, 2023, shall not impose a deductible, coinsurance, or other cost-sharing requirement on an insulin prescription, except for a copayment subject to the limitations in paragraph (1).(3) Paragraphs (1) and (2) shall only apply to one of each dosage form and insulin type.(4) A health insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible requirement on a benefit described in subdivision (a).(e) A health insurer shall provide coverage for diabetes outpatient self-management training, education, and medical nutrition therapy necessary to enable an insured to properly use the equipment, supplies, and medications set forth in subdivisions (a) and (b) and additional diabetes outpatient self-management training, education, and medical nutrition therapy upon the direction or prescription of those services by the insureds participating physician. If an insurer delegates outpatient self-management training to contracting providers, the insurer shall require contracting providers to ensure that diabetes outpatient self-management training, education, and medical nutrition therapy are provided by appropriately licensed or registered health care professionals.(f) The diabetes outpatient self-management training, education, and medical nutrition therapy services identified in subdivision (e) shall be provided by appropriately licensed or registered health care professionals as prescribed by a health care professional legally authorized to prescribe the services.(g) The coinsurances and deductibles for the benefits specified in subdivision (e) shall not exceed those established for physician office visits by the insurer.(h) A health insurer governed by this section shall disclose the benefits covered pursuant to this section in the insurers evidence of coverage and disclosure forms.(i) A health insurer shall not reduce or eliminate coverage as a result of this section.(j) This section does not apply to vision-only, dental-only, accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, or disability income insurance, except that for accident-only, specified disease, and hospital indemnity insurance coverage, benefits under this section only apply to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy. This section does not impose a new benefit mandate on accident-only, specified disease, or hospital indemnity insurance.
184147
185148
186149
187150 10176.61. (a) A health insurance policy issued, amended, or renewed on or after January 1, 2000, shall include coverage for the following equipment and supplies for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes as medically necessary, even if the items are available without a prescription:
188151
189152 (1) Blood glucose monitors and blood glucose testing strips.
190153
191154 (2) Blood glucose monitors designed to assist the visually impaired.
192155
193156 (3) Insulin pumps and all related necessary supplies.
194157
195158 (4) Ketone urine testing strips.
196159
197160 (5) Lancets and lancet puncture devices.
198161
199162 (6) Pen delivery systems for the administration of insulin.
200163
201164 (7) Podiatric devices to prevent or treat diabetes-related complications.
202165
203166 (8) Insulin syringes.
204167
205168 (9) Visual aids, excluding eyewear, to assist the visually impaired with proper dosing of insulin.
206169
207-(b) A health insurance policy that is issued, amended, or renewed on or after January 1, 2000, that covers prescription drug benefits shall include coverage for the following prescription items if the items are determined to be medically necessary:
170+(b) A health insurance policy that is issued, amended, or renewed on or after January 1, 2000, that covers prescription benefits shall include coverage for the following prescription items if the items are determined to be medically necessary:
208171
209172 (1) Insulin.
210173
211174 (2) Prescriptive medications for the treatment of diabetes.
212175
213176 (3) Glucagon.
214177
215178 (c) The coinsurances and deductibles for the benefits specified in subdivisions (a) and (b) shall not exceed those established for similar benefits within the given policy.
216179
217-(d) (1) Notwithstanding subdivision (c), for a health insurance policy that is issued, amended, or renewed on or after January 1, 2023, the copayment for an insulin prescription covered pursuant to subdivision (b) shall not exceed thirty-five dollars ($35) per month per each dosage form of insulin products. shall cover all available dosage forms and concentrations of at least one insulin product of each insulin type for a copayment of no more than thirty-five dollars ($35) for a monthly supply. If a policy covers prescription drugs in larger amounts than a monthly supply, the copayment on that amount shall be equal to or less than the multiple of the monthly supply copayment, so that the respective copayment for a 60-day or 90-day supply shall not exceed seventy dollars ($70) or one hundred five dollars ($105).
180+(d) (1) Notwithstanding subdivision (c), for a health insurance policy that is issued, amended, or renewed on or after January 1, 2023, the copayment for an insulin prescription covered pursuant to subdivision (b) shall not exceed thirty-five dollars ($35) per month per each dosage form of insulin products.
218181
219-(2) A health insurance policy that is issued, amended, or renewed on or after January 1, 2023, shall not impose a deductible, coinsurance, or other cost-sharing requirement on an insulin prescription, prescription covered pursuant to paragraph (1), except for a copayment subject to the limitations in paragraph (1).
182+(2) A health insurance policy that is issued, amended, or renewed on or after January 1, 2023, shall not impose a deductible, coinsurance, or other cost-sharing requirement on an insulin prescription, except for a copayment subject to the limitations in paragraph (1).
220183
221184 (3) Paragraphs (1) and (2) shall only apply to one of each dosage form and insulin type.
222185
186+(4) A health insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible requirement on a benefit described in subdivision (a).
223187
188+(e) A health insurer shall provide coverage for diabetes outpatient self-management training, education, and medical nutrition therapy necessary to enable an insured to properly use the equipment, supplies, and medications set forth in subdivisions (a) and (b) and additional diabetes outpatient self-management training, education, and medical nutrition therapy upon the direction or prescription of those services by the insureds participating physician. If an insurer delegates outpatient self-management training to contracting providers, the insurer shall require contracting providers to ensure that diabetes outpatient self-management training, education, and medical nutrition therapy are provided by appropriately licensed or registered health care professionals.
224189
225-(3) For purposes of this subdivision:
190+(f) The diabetes outpatient self-management training, education, and medical nutrition therapy services identified in subdivision (e) shall be provided by appropriately licensed or registered health care professionals as prescribed by a health care professional legally authorized to prescribe the services.
226191
227-(A) Dosage form means the form in which insulin is packaged, including vial and pen delivery device.
192+(g) The coinsurances and deductibles for the benefits specified in subdivision (e) shall not exceed those established for physician office visits by the insurer.
228193
229-(B) Insulin type means rapid-acting, short-acting, intermediate-acting, or long-acting insulin.
194+(h) A health insurer governed by this section shall disclose the benefits covered pursuant to this section in the insurers evidence of coverage and disclosure forms.
230195
231-(4)
196+(i) A health insurer shall not reduce or eliminate coverage as a result of this section.
232197
233-
234-
235-(e) A health insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2023, shall not impose a deductible requirement on a benefit described in subdivision (a). If a health insurance policy is a high deductible health plan, as defined in Section 223(c)(2) of Title 26 of the United States Code, the policy shall not impose a deductible requirement on a benefit described in paragraph (1) or (2) of subdivision (a), or any other benefit described in subdivision (a) for which the Internal Revenue Service has indicated that the minimum deductible may be waived in a high deductible health plan.
236-
237-(e)
238-
239-
240-
241-(f) A health insurer shall provide coverage for diabetes outpatient self-management training, education, and medical nutrition therapy necessary to enable an insured to properly use the equipment, supplies, and medications set forth in subdivisions (a) and (b) and additional diabetes outpatient self-management training, education, and medical nutrition therapy upon the direction or prescription of those services by the insureds participating physician. If an insurer delegates outpatient self-management training to contracting providers, the insurer shall require contracting providers to ensure that diabetes outpatient self-management training, education, and medical nutrition therapy are provided by appropriately licensed or registered health care professionals.
242-
243-(f)
244-
245-
246-
247-(g) The diabetes outpatient self-management training, education, and medical nutrition therapy services identified in subdivision (e) (f) shall be provided by appropriately licensed or registered health care professionals as prescribed by a health care professional legally authorized to prescribe the services.
248-
249-(g)
250-
251-
252-
253-(h) The coinsurances and deductibles for the benefits specified in subdivision (e) (f) shall not exceed those established for physician office visits by the insurer.
254-
255-(h)
256-
257-
258-
259-(i) A health insurer governed by this section shall disclose the benefits covered pursuant to this section in the insurers evidence of coverage and disclosure policy forms.
260-
261-(i)
262-
263-
264-
265-(j) A health insurer shall not reduce or eliminate coverage as a result of this section.
266-
267-(j)
268-
269-
270-
271-(k) This section does not apply to vision-only, dental-only, accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, or disability income insurance, except that for accident-only, specified disease, and hospital indemnity insurance coverage, benefits under this section only apply to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy. This section does not impose a new benefit mandate on accident-only, specified disease, or hospital indemnity insurance.
198+(j) This section does not apply to vision-only, dental-only, accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, or disability income insurance, except that for accident-only, specified disease, and hospital indemnity insurance coverage, benefits under this section only apply to the extent that the benefits are covered under the general terms and conditions that apply to all other benefits under the policy. This section does not impose a new benefit mandate on accident-only, specified disease, or hospital indemnity insurance.
272199
273200 SEC. 4. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
274201
275202 SEC. 4. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
276203
277204 SEC. 4. No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
278205
279206 ### SEC. 4.