UNOFFICIAL COPY 23 RS BR 296
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AN ACT relating to coverage for diabetes treatment. 1
Be it enacted by the General Assembly of the Commonwealth of Kentucky: 2
Section 1. KRS 304.17A-148 is amended to read as follows: 3
(1) As used in this section: 4
(a) "Cost sharing" has the same meaning as in KRS 304.17A-164; and 5
(b) "Utilization review": 6
1. Has the same meaning as in KRS 304.17A-600; and 7
2. Shall include prior authorization, step therapy protocol, drug 8
formulary restrictions, and any other utilization management 9
requirements. 10
(2) All health benefit plans[ issued or renewed on or after January 1, 2022,] shall 11
provide coverage for equipment, supplies, outpatient self-management training and 12
education, including medical nutrition therapy, and all medications prescribed by a 13
health care provider[necessary] for the treatment of insulin-dependent diabetes, 14
insulin-using diabetes, gestational diabetes, and noninsulin-using diabetes if 15
the[prescribed by a] health care provider is legally authorized to prescribe the items. 16
(3)[(2)] Diabetes outpatient self-management training and education shall be provided 17
by a certified, registered, or licensed health care professional with expertise in 18
diabetes, as deemed necessary by a health care provider. 19
(4)[(3)] (a) Except as provided in paragraphs[paragraph] (b) and (c) of this 20
subsection, the benefits provided in this section shall be subject to the same 21
annual deductibles or coinsurance established for all other covered benefits 22
within a given health benefit plan. 23
(b) Cost sharing for a covered prescription insulin drug shall not exceed thirty 24
dollars ($30) per thirty (30) day supply of each prescription insulin drug, 25
regardless of the amount or type of insulin needed to meet the 26
insured's[covered person's] insulin needs. 27 UNOFFICIAL COPY 23 RS BR 296
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(c) 1. Except as provided in subparagraph 2. of this paragraph, cost sharing 1
for the following equipment and supplies shall not exceed eighty 2
dollars ($80) for each piece of equipment or, if applicable, per thirty 3
(30) day supply: 4
a. Blood glucose monitors, including continuous glucose monitors; 5
b. Monitor supplies; 6
c. Medication injection aids; 7
d. Syringes; 8
e. Medication infusion devices; 9
f. Pharmacological agents for controlling blood sugar; and 10
g. Orthotics. 11
2. The cost-sharing limit for equipment and supplies established in 12
subparagraph 1. of this paragraph may be adjusted annually by the 13
percent increase in the nonseasonally adjusted annual average 14
Consumer Price Index for All Urban Consumers (CPI-U), U.S. City 15
Average, Medical Care, between the two (2) most recent calendar 16
years available, as published by the United States Bureau of Labor 17
Statistics. 18
(d)[(c)] Private third-party payors may not reduce or eliminate coverage due to 19
the requirements of this section. 20
(e)[(d)] Except as provided in KRS 18A.225, paragraphs[paragraph] (b) and (c) 21
of this subsection shall not apply to governmental plans[, as defined in KRS 22
304.17A-005,] that are self-insured. 23
(f)[(e)] Nothing in this subsection shall prevent an insurer from establishing cost 24
sharing[cost-sharing requirements] for any benefit provided in this section 25
that is[covered prescription insulin drugs] below the amount specified in[ 26
paragraph (b) of] this subsection. 27 UNOFFICIAL COPY 23 RS BR 296
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(5) Notwithstanding any other provision of this subtitle, an insurer shall not conduct 1
or impose utilization review for any equipment, supplies, outpatient self-2
management training and education, including medical nutrition therapy, or 3
medications prescribed in accordance with this section. 4
[(4) As used in this section, "cost sharing" has the same meaning as in KRS 304.17A-5
164.] 6
Section 2. This Act applies to health benefit plans issued or renewed on or after 7
January 1, 2024. 8
Section 3. This Act takes effect on January 1, 2024. 9