KS
Kansas House Bill HB2347

Kansas 2023-2024 Regular Session

Kansas House Bill HB2347 Compare Versions

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11 Session of 2023
22 HOUSE BILL No. 2347
33 By Committee on Health and Human Services
44 2-8
55 AN ACT concerning health and healthcare; relating to prescription drugs;
66 insulin drugs and devices for the management of diabetes; providing
77 price limitations and requirements therefor under health insurance
88 plans; establishing the insulin affordability program for the uninsured
99 and procedures to acquire emergency insulin supplies.
1010 Be it enacted by the Legislature of the State of Kansas:
1111 Section 1. (a) Every individual or group health insurance policy,
1212 medical service plan, contract, hospital service corporation contract,
1313 hospital and medical service corporation contract, fraternal benefit society
1414 or health maintenance organization that provides coverage for accident and
1515 health services and that is delivered, issued for delivery, amended or
1616 renewed on or after January 1, 2024, shall provide coverage for
1717 prescription insulin drugs in accordance with this section.
1818 (b) All coverage for accident and health services described in
1919 subsection (a) shall limit the total amount that a covered person is required
2020 to pay for a 30-day supply for:
2121 (1) All covered prescription insulin drugs, including any amount or
2222 type of insulin needed to fill the covered person's prescription and any
2323 number of prescriptions filled, to an amount not to exceed $35; and
2424 (2) all devices, to an amount not to exceed $100.
2525 (c) All coverage for accident and health services described in
2626 subsection (a) shall cover:
2727 (1) At least one type of prescription insulin drug in each of the
2828 following categories:
2929 (A) Rapid acting;
3030 (B) ultra rapid acting;
3131 (C) short acting;
3232 (D) intermediate acting;
3333 (E) long acting;
3434 (F) pre-mixed insulin products;
3535 (G) pre-mixed insulin/GLP-1 RA products; and
3636 (H) concentrated human regular insulin; and
3737 (2) diabetes self-management education to ensure that persons with
3838 diabetes are educated on the proper self-management and treatment of
3939 diabetes, including, but not limited to, information on proper diets,
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7676 provided by a healthcare provider who has been appropriately trained as
7777 specified in rules and regulations adopted by the secretary of health and
7878 environment.
7979 (d) Any provider of coverage for accident and health services
8080 described in subsection (a) shall provide an appeals process for covered
8181 persons who are not able to take one or more of the prescription insulin
8282 drugs described in subsection (c)(1). Such appeals process shall be
8383 provided in writing and shall provide covered persons and the covered
8484 person's healthcare providers a meaningful opportunity to participate in the
8585 appeals process.
8686 (e) (1) The commissioner of insurance shall adopt rules and
8787 regulations as necessary to implement this section.
8888 (2) The secretary of health and environment shall adopt rules and
8989 regulations to establish training requirements for healthcare providers
9090 providing diabetes self-management education required to be covered
9191 under subsection (c)(2).
9292 (f) (1) No contract between a provider of coverage for accident and
9393 health services described in subsection (a) and a pharmacy benefits
9494 manager, as defined in K.S.A. 40-3822, and amendments thereto, shall
9595 contain any provision that allows any charge, collection or other required
9696 payment that exceeds the limitations provided in subsection (b).
9797 (2) A pharmacy benefits manager, provider of coverage for accident
9898 and health services described in subsection (a) or any other third party that
9999 reimburses a pharmacy for drugs or services shall not reimburse a
100100 pharmacy at a lower rate or assess any fee, charge-back or adjustment
101101 upon a pharmacy on the basis that a covered person's cost-sharing
102102 requirements are being affected.
103103 (g) As used in this section:
104104 (1) "Device" means a blood glucose test strip, glucometer, continuous
105105 glucose monitor and transmitter, lancet, lancing device or insulin syringe
106106 used to cure, diagnose, mitigate, prevent or treat diabetes or low blood
107107 sugar. "Device" does not include an insulin pump.
108108 (2) "Prescription insulin drug" means a prescription drug that
109109 contains insulin and is used to treat diabetes.
110110 Sec. 2. (a) On and after January 1, 2024, there is created the insulin
111111 affordability program for the uninsured. Prior to January 1, 2024, each
112112 manufacturer shall establish procedures to make insulin available to
113113 eligible individuals in accordance with this section.
114114 (b) To be eligible to receive insulin under the program, an individual
115115 shall:
116116 (1) Be a resident of Kansas;
117117 (2) not be eligible for or enrolled in medical assistance or the federal
118118 health insurance for the aged act, 42 U.S.C. § 1395 et seq.;
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162162 (3) have a valid prescription order for insulin; and
163163 (4) not be enrolled in coverage for accident and health services
164164 subject to the requirements of section 1, and amendments thereto. An
165165 individual enrolled in short-term coverage, a healthcare sharing ministry or
166166 self-insured coverage shall not be excluded from eligibility under this
167167 paragraph.
168168 (c) The commissioner of insurance shall develop an application form
169169 to be used by an individual who is seeking insulin under the program and
170170 make such form available on the insurance department's website and to
171171 pharmacies, healthcare providers and healthcare facilities that prescribe or
172172 dispense insulin.
173173 (d) (1) To acquire insulin through the program, an individual shall
174174 present to a pharmacy a completed, signed and dated application form with
175175 proof of the individual's Kansas residency. If the individual is younger
176176 than 18 years of age, the individual's parent or legal guardian may provide
177177 such proof of residency.
178178 (2) Upon receipt of an application form meeting the requirements of
179179 paragraph (1) and demonstrating eligibility pursuant to subsection (b), a
180180 pharmacist shall dispense the prescribed insulin in an amount that will
181181 provide the individual with a 30-day supply of insulin.
182182 (3) An individual may receive 30-day supplies of insulin for up to 12
183183 months per valid application and may reapply for additional 12-month
184184 periods.
185185 (e) (1) A pharmacist dispensing insulin pursuant to subsection (d)
186186 may inform the individual that the individual may be eligible for medical
187187 assistance or an affordable insurance product on the state-based
188188 marketplace.
189189 (2) A pharmacist shall retain a copy of any application form provided
190190 by an individual pursuant to this section for two years after the date the
191191 insulin was initially dispensed.
192192 (3) A pharmacy dispensing insulin pursuant to this section may
193193 collect a one-time fee from the individual in an amount not to exceed $15.
194194 (f) (1) Except as provided in paragraph (4), unless the manufacturer
195195 agrees to send the pharmacy a replacement supply of insulin dispensed in
196196 the amount provided through the program, the pharmacy may submit to
197197 the manufacturer an electronic claim for payment that is made in
198198 accordance with the national council for prescription drug programs'
199199 standards for electronic claims processing, or other substantially
200200 equivalent standards determined by the commissioner of insurance.
201201 (2) Prior to January 1, 2024, each manufacturer shall develop a
202202 process for a pharmacy to submit an electronic claim for reimbursement as
203203 provided in paragraph (1).
204204 (3) If a pharmacy submits an electronic claim to a manufacturer
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248248 pursuant to this subsection, within 30 calendar days after receipt of the
249249 claim, the manufacturer shall reimburse the pharmacy in an amount, or
250250 send the pharmacy a replacement supply of the same insulin in an equal or
251251 greater amount, that covers the difference between the pharmacy's
252252 wholesale acquisition cost for the insulin dispensed through the program
253253 and the amount that the individual paid for the insulin pursuant to
254254 subsection (e)(3).
255255 (4) A pharmacy shall not submit a claim for payment for insulin with
256256 a wholesale acquisition cost of $8 or less per milliliter, adjusted annually
257257 based on the annual percentage change in the consumer price index as
258258 determined by the commissioner of insurance.
259259 (g) The commissioner of insurance may promote the availability of
260260 the program to Kansans. Promotional material provided by the
261261 commissioner may include information regarding each manufacturer's
262262 consumer insulin programs. The insurance department may accept gifts,
263263 grants and donations to meet the requirements of this subsection.
264264 (h) The commissioner of insurance may impose a fine of $10,000
265265 upon a manufacturer that fails to comply with the requirements of this
266266 section for each month of noncompliance.
267267 (i) The commissioner of insurance shall adopt rules and regulations
268268 as necessary to implement this section.
269269 (j) As used in this section:
270270 (1) "Consumer price index" means the consumer price index for all
271271 urban consumers in the midwest region published by the United States
272272 department of labor, bureau of labor statistics.
273273 (2) "Manufacturer" means an entity:
274274 (A) Engaged in the manufacture of insulin that is self-administered on
275275 an outpatient basis and is available for purchase by residents of this state;
276276 and
277277 (B) that has an annual gross revenue of more than $2,000,000 from
278278 the sale of insulin in this state.
279279 (3) "Pharmacist" and "pharmacy" mean the same as defined in K.S.A.
280280 65-1626, and amendments thereto.
281281 (4) "Wholesale acquisition cost" means a manufacturer's list price for
282282 insulin to wholesalers or direct purchasers in the United States for the most
283283 recent month for which the information is reported in wholesale price
284284 guides or other publications of drug or biological pricing data. "Wholesale
285285 acquisition cost" does not include prompt pay or other discounts, rebates
286286 or reductions in price.
287287 Sec. 3. (a) (1) On and after January 1, 2024, an individual may
288288 acquire from a pharmacy one emergency 30-day supply of prescription
289289 insulin drugs within a 12-month period. The pharmacy may charge the
290290 individual an amount not to exceed $35 for such 30-day supply.
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334334 (2) Each manufacturer shall establish procedures to make insulin
335335 available in accordance with this section to eligible individuals who need
336336 access to an emergency prescription insulin drug supply.
337337 (b) To be eligible to receive an emergency prescription insulin drug
338338 supply, an individual shall:
339339 (1) Be a resident of Kansas;
340340 (2) have a valid prescription for insulin;
341341 (3) have less than a seven-day supply of insulin available; and
342342 (4) be required to pay more than $100 out of pocket each month for
343343 prescribed insulin drugs, whether insured or uninsured.
344344 (c) (1) The commissioner of insurance shall create and make
345345 available to the public an application form for individuals seeking to
346346 acquire an emergency prescription insulin drug supply pursuant to this
347347 section. Such application form shall require an individual to provide proof
348348 of eligibility under subsection (b).
349349 (2) Each pharmacy in this state shall make the application form
350350 available at the pharmacy.
351351 (d) (1) To acquire an emergency 30-day supply of insulin under this
352352 section, an individual shall present to a pharmacy a completed, signed and
353353 dated application form with proof of the individual's Kansas residency. If
354354 the individual is younger than 18 years of age, the individual's parent or
355355 legal guardian may provide such proof of residency.
356356 (2) Upon receipt of an application form meeting the requirements of
357357 paragraph (1) and demonstrating eligibility pursuant to subsection (b), a
358358 pharmacist shall dispense the prescribed insulin in an amount that will
359359 provide the individual with a 30-day supply.
360360 (e) (1) A pharmacist shall retain a copy of any application form
361361 provided by an individual pursuant to this section for two years after the
362362 date the insulin was initially dispensed.
363363 (2) A pharmacy dispensing insulin pursuant to this section may
364364 collect a copayment from the individual to cover the pharmacy's costs of
365365 processing and dispensing the insulin in an amount not to exceed $35 for
366366 the emergency 30-day supply of insulin.
367367 (f) (1) Except as provided in paragraph (4), unless the manufacturer
368368 agrees to send the pharmacy a replacement supply of insulin dispensed in
369369 the amount provided through the program, the pharmacy may submit to
370370 the manufacturer an electronic claim for payment that is made in
371371 accordance with the national council for prescription drug programs'
372372 standards for electronic claims processing, or other substantially
373373 equivalent standards determined by the commissioner of insurance.
374374 (2) Prior to January 1, 2024, each manufacturer shall develop a
375375 process for a pharmacy to submit an electronic claim for reimbursement as
376376 provided in paragraph (1).
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420420 (3) If a pharmacy submits an electronic claim to a manufacturer
421421 pursuant to this subsection, within 30 calendar days after receipt of the
422422 claim, the manufacturer shall reimburse the pharmacy in an amount, or
423423 send the pharmacy a replacement supply of the same insulin in an equal or
424424 greater amount, that covers the difference between the pharmacy's
425425 wholesale acquisition cost for the insulin dispensed through the program
426426 and the amount that the individual paid for the insulin pursuant to
427427 subsection (e)(3).
428428 (4) A pharmacy shall not submit a claim for payment for insulin with
429429 a wholesale acquisition cost of $8 or less per milliliter, adjusted annually
430430 based on the annual percentage change in the consumer price index as
431431 determined by the commissioner of insurance.
432432 (g) The commissioner of insurance shall promote the availability of
433433 emergency insulin under this section to Kansans. Promotional material
434434 provided by the commissioner shall include information regarding each
435435 manufacturer's consumer insulin programs. The insurance department may
436436 accept gifts, grants and donations to meet the requirements of this
437437 subsection.
438438 (h) The commissioner of insurance may impose a fine of $10,000
439439 upon a manufacturer that fails to comply with the requirements of this
440440 section for each month of noncompliance.
441441 (i) The commissioner of insurance shall adopt rules and regulations
442442 as necessary to implement this section.
443443 (j) As used in this section, "consumer price index," "manufacturer,"
444444 "pharmacist," "pharmacy" and "wholesale acquisition cost" mean the same
445445 as defined in section 2, and amendments thereto.
446446 Sec. 4. This act shall take effect and be in force from and after its
447447 publication in the statute book.
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