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STATE OF OKLAHOMA
1st Session of the 59th Legislature (2023)
SENATE BILL 142 By: Hicks
AS INTRODUCED
An Act relating to health insurance; amending 36 O.S.
2021, Section 6060.2, as amended by Section 1,
Chapter 199, O.S.L. 2022 (36 O.S. Sup p. 2022, Section
6060.2), which relates to treatment of diabetes;
modifying copayment cap of certain insulin supply;
requiring cap on copayment for certain diabetes
equipment and supplies; requiring reduction in cost-
sharing amount for certain insulin supply or diabetes
equipment or supply that is less than copayment cap;
conforming language; and providing an effective dat e.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 36 O.S. 2021, Section 6060.2, as
amended by Section 1, Chapter 199 , O.S.L. 2022 (36 O.S. Supp. 2022,
Section 6060.2), is amended to read as follows:
Section 6060.2. A. 1. Every health benefit plan issued or
renewed on or after November 1, 1996, shall, subject to the te rms of
the policy contract or agreement, i nclude coverage for the following
equipment, supplies and related services for the treatment of Type
I, Type II, and gestational diabetes, when medically necessary and
when recommended or prescribed by a physician or other licensed
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health care provider leg ally authorized to prescribe under the laws
of this state:
a. blood glucose monitors,
b. blood glucose monitors to the legally bl ind,
c. test strips for glucose monito rs,
d. visual reading and urine testing strips,
e. insulin,
f. injection aids,
g. cartridges for the legally blind,
h. syringes,
i. insulin pumps and appurtenances thereto,
j. insulin infusion devices,
k. oral agents for controlling blood sugar, and
l. podiatric appliances for prevention of complicatio ns
associated with diabetes.
2. The State Board of Health shall develop and annually update,
by rule, a list of additional diabetes equipment, related supplies
and health care provider services that are medic ally necessary for
the treatment of diabetes, f or which coverage shall also be
included, subject to the terms of the policy, contract, or
agreement, if the equipment and supplies have been approved by the
federal Food and Drug Administration (FDA). Additi onal FDA-approved
diabetes equipment and relate d supplies, and health care provider
services, shall be determined in consultation with a national
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diabetes association affiliated with this state, and at least three
(3) medical directors of health benefit pl ans, to be selected by the
State Department of H ealth.
3. All policies specified in this section shall also include
coverage for:
a. podiatric health care provider services as are deemed
medically necessary to prevent complications from
diabetes, and
b. diabetes self-management training. As used in th is
subparagraph, “diabetes self-management training”
means instruction in an inpatient or outpatient
setting which enables diabetic patients to understand
the diabetic management process and daily management
of diabetic therapy as a method of avoiding freq uent
hospitalizations and complications. Diabetes self-
management training shall comply with standards
developed by the State Board of Health in consultation
with a national diabetes association affiliated w ith
this state and at least three medical direct ors of
health benefit plans selected by th e State Department
of Health. Coverage for diabetes self-management
training, including medical nutrition therapy relating
to diet, caloric intake, and diabetes mana gement, but
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excluding programs the only purpose of which are
weight reduction, shall be li mited to the following:
(1) visits medically necessary upon the diagnosis of
diabetes,
(2) a physician diagnosis which represents a
significant change in the symptoms or condition
of the patient making medically ne cessary changes
in the self-management of the patient, and
(3) visits when reeducation or refresher training is
medically necessary;
provided, however, payment for the cov erage required for diabetes
self-management training pursuant to the provisions of th is section
shall be required only upon cer tification by the health care
provider providing the training that the patient has successfully
completed diabetes self -management training.
4. Diabetes self-management training shall be supervised by a
licensed physician or other licensed health care pr ovider legally
authorized to prescribe under the laws of this state. Diabetes
self-management training may be provided by the phy sician or other
appropriately registe red, certified, or licensed health care
professional as part of an office visit for diabe tes diagnosis or
treatment. Training provided by appropriately registered,
certified, or licensed health care professionals may b e provided in
group settings where pr acticable.
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5. Coverage for diabetes self -management training and training
related to medical nutrition therapy, when provided by a registered,
certified, or licensed health care professional, shall also include
home visits when medically necessary and sha ll include instruction
in medical nutrition ther apy only by a licensed registered dietic ian
or licensed certified nutritionist when authorized by the
supervising physician of the patient when medically necessary.
6. Coverage Except as provided in paragrap h 7 of this
subsection, coverage may be subject to the same annual deductibles
or coinsurance as may be deemed appropriate and as are is consistent
with those established for other covered benefits within a given
policy.
7. Any health benefit plan, as defined pursuant to Section
6060.4 of this title, that provides coverage for insulin pursuant to
this section shall cap the t otal amount that a cov ered person is
required to pay for insulin at an amount not to exceed Thirty
Dollars ($30.00) Twenty-five Dollars ($25.00) per thirty-day supply
or Ninety Dollars ($90.00) per ninety-day supply of insulin for each
covered insulin prescription, regardless of the a mount or type of
insulin needed to fill the prescription or prescriptions of the
covered person. If an FDA-approved diabetes equipment or supply
product cost exceeds Thirty-five Dollars ($35.00), the health
benefit plan shall cap the total amount that an insured is required
to pay for a thirty-day supply at an amount not to exceed Thirty-
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five Dollars ($35.00). Provided, however, in the event that the
cost of the thirty-day supply, ninety-day supply, or FDA-approved
diabetes equipment or supply product is less than the copayment cap
pursuant to this paragraph, a health benefit plan shall reduce the
cost-sharing amount of an insured to the lesser assigned copayment
of the supply or product to the insured.
a. Nothing in this paragraph shall prev ent a health
benefit plan from reducing the cos t-sharing of a
covered person to an a mount less than Thirty Dollars
($30.00) per thirty-day supply or Ninety Dollars
($90.00) per ninety-day supply.
b. The Insurance Commissioner shall ensure all health
benefit plans comply with the requirements of this
paragraph.
c. b. The Commissioner may promulgate rules as ne cessary to
implement and administer the requirements of this
paragraph and to align with federal requirements.
B. 1. Health benefit plans shall not reduce or eliminate
coverage due to the requirements of this section.
2. Enforcement of the provisions of this act section shall be
performed by the Insurance Department and the State Department of
Health.
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C. As used in this section, “health benefit plan” means any
plan or arrangement as d efined in subsection C of Section 6060.4 of
this title.
SECTION 2. This act shall become effective November 1, 2023.
59-1-1197 RD 1/4/2023 3:35:13 PM