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STATE OF OKLAHOMA
1st Session of the 59th Legislature (2023)
HOUSE BILL 2351 By: Dempsey
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. Supp. 2022, Section
6060.2), which relates to the treatment of diabetes;
defining terms; directing the Insura nce Department
and the State Department of Health to purchase
insulin at discounted prices; creating a program that
allows Oklahomans to purchase discounted insulin;
providing for codification ; and providing an
effective date.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHO MA:
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, s hall, subject to the terms of
the policy contract or agreement, i nclude coverage for the following
equipment, supplies and related services for th e treatment of Type
I, Type II, and gestational diabetes, when medic ally necessary and
when recommended or pre scribed by a physician or other license d
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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 blind,
c. test strips for glucose monitors,
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 theret o,
j. insulin infusion devices,
k. oral agents for controlling blood sugar, and
l. podiatric appliances for pr evention of complications
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 servi ces that are medically necessary for
the treatment of diabetes, for which coverag e 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 Administrat ion (FDA). Additional FDA-approved
diabetes equipment and related supplies, and health care provider
services shall be determined in consultation with a national
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diabetes association affi liated with this state, and at least three
(3) medical directors of health benefit plans, to be selected by th e
State Department of Health.
3. All policies specified in this section shall also include
coverage for:
a. podiatric health care provider servic es as are deemed
medically necessary to prevent complications from
diabetes, and
b. diabetes self-management training. As used in this
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 frequent
hospitalizations and complications. Diabetes self-
management training shall comply with standards
developed by the State Board of Health in consultation
with a national diabetes associa tion affiliated with
this state and at lea st three medical directors 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 management, 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 necessary changes
in the self-management of the patient, and
(3) visits when reeducation or refresher training is
medically necessary;
provided, however, payment for the coverage required for d iabetes
self-management training pursuant to the provisions of this section
shall be required only upon cer tification by the health care
provider providing the training that the patient ha s successfully
completed diabetes self -management training.
4. Diabetes self-management training shall be sup ervised by a
licensed physician or othe r licensed health care pr ovider legally
authorized to prescribe under the laws of this state. Diabetes
self-management training may be provided by the physician or other
appropriately registered, certified, or licens ed 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 be provided in
group settings where practicable.
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5. Coverage for diabetes self-management training an d training
related to medical nutrition therapy, when provided by a registered,
certified, or licensed heal th care professional, shall also include
home visits when medically necessary and shall include instruction
in medical nutrition therapy only by a li censed registered dietic ian
or licensed certified nutritionist when authorized by the
supervising physician of the patient when medically necessary.
6. Coverage may be subjec t to the same annual deductibles or
coinsurance as may be deemed appropriate and as are 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) 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 insul in needed to
fill the prescription or prescriptions of the covered person.
a. Nothing in this paragraph shall prev ent a health
benefit plan from reducing the cos t-sharing of a
covered person to an amount less than Thirty Dolla rs
($30.00) per thirty-day supply or Ninety Dollars
($90.00) per ninety-day supply.
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b. The Insurance Commissioner shall ens ure all health
benefit plans comply with the requirements of this
paragraph.
c. The Commissioner may promulgat e rules as necessary 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 requirement s of this section.
2. Enforcement of the provisions of this act shall be performed
by the Insurance Department and the State Department of Health.
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. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 6060.2a of Title 36, unless
there is created a duplication in numbering, reads as follows:
A. The State shall direct the creation of a discount progr am
that will allow participants to purchase insul in at a discounted,
post-rebate rate.
B. As used in this section , unless the context otherwise
requires:
1. "Participant" means a resident of Oklahoma who:
a. uses insulin to treat diabetes,
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b. does not receive health coverage un der the program,
and
c. enrolls in the discount program;
2. "Discount program" means a process developed by the program
that allows participants to purchase insulin at a discounted, post -
rebate rate;
3. "Rebate" means a refund, discount or other price concession
that is paid by a pharmaceutica l manufacturer to a pharmacy benefit
manager based on a prescription drug's utilization or effectiveness.
"Rebate" does not include an administrative fee.
C. For the purpose of the insulin discount program only, the
program shall allow participants to purchase insul in at a
discounted, post-rebate rate.
D. The discount program described in this section shall:
1. Provide a participant with an electroni c document that
identifies the participant as eligible for the discount;
2. Provide a participant with information a bout pharmacies that
will honor the discount;
3. Allow a participant to purchase insulin at a discounted,
post-rebate rate; and
4. Provide a participant with instructions to pursue a
reimbursement of the purchase price from the participant 's health
insurer.
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E. The discount program shall charge a p rice for the insulin
that allows the program to retain only enough of any rebate for the
insulin to make the state risk pool whole for providing discounted
insulin to participants.
SECTION 3. This act shall become effective November 1, 2023.
59-1-6206 TJ 12/13/22