Oklahoma 2024 Regular Session

Oklahoma House Bill HB2351 Compare Versions

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3		-	ENGR. H. B. NO. 2351 Page 1 1
	3	+	HB2351 HFLR Page 1
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28		-	ENGROSSED HOUSE
29		-	BILL NO. 2351 By: Dempsey and Davis of the
30		-	House
	29	+	HOUSE OF REPRESENTATIVES - FLOOR VERSION
31	30
32		-	~~and~~
	31	+	STATE OF OKLAHOMA
33	32
34		-	Hicks of the Senate
	33	+	1st Session of the 59th Legislature (2023)
	34	+
	35	+	HOUSE BILL 2351 By: Dempsey
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40		-	[ health insurance - treatment of diabetes - program
41		-	that allows Oklahomans to purchase discounted
42		-	insulin – codification - effective date ]
	41	+	AS INTRODUCED
	42	+
	43	+	An Act relating to health insurance; amending 36 O.S.
	44	+	2021, Section 6060.2 as amended by Section 1, Chapter
	45	+	199, O.S.L. 2022 (36 O.S. Supp. 2022, Section
	46	+	6060.2), which relates to the treatment of diabetes;
	47	+	defining terms; directing the Insura nce Department
	48	+	and the State Department of Health to purchase
	49	+	insulin at discounted prices; creating a program that
	50	+	allows Oklahomans to purchase discounted insulin;
	51	+	providing for codification ; and providing an
	52	+	effective date.
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47	57		BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHO MA:
48		-	SECTION 1. NEW LAW A new section of law to be codified
49		-	in the Oklahoma Statutes as Section 6060.2a of Title 36, unless
50		-	there is created a duplication in numbering, reads as follows:
51		-	A. The State shall direct the creation of a discount progr am
52		-	that will allow participants t o purchase insulin at a discounted,
53		-	post-rebate rate.
54		-	B. As used in this section , unless the context otherwise
55		-	requires:
56		-	1. "Participant" means a resident of Oklahoma who:
57		-	a. uses insulin to treat diabetes,
58		-	b. does not receive health coverage un der the program,
59		-	and
	58	+	SECTION 1. AMENDATORY 36 O.S. 2021, Section 6060.2, as
	59	+	amended by Section 1, Chapter 199 , O.S.L. 2022 (36 O.S. Supp. 2022,
	60	+	Section 6060.2), is amended to read as follows :
	61	+	Section 6060.2 A. 1. Every health benefit plan issued or
	62	+	renewed on or after November 1, 1996, s hall, subject to the terms of
	63	+	the policy contract or agreement, i nclude coverage for the following
	64	+	equipment, supplies and related services for th e treatment of Type
	65	+	I, Type II, and gestational diabetes, when medic ally necessary and
	66	+	when recommended or pre scribed by a physician or other l icensed
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61		-	ENGR. H. B. NO. 2351 Page 2 1
	68	+	HB2351 HFLR Page 2
	69	+	BOLD FACE denotes Committee Amen dments. 1
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86		-	c. enrolls in the discount program;
87		-	2. "Discount program" means a process developed by the program
88		-	that allows participants to purchase insulin at a discounted, post-
89		-	rebate rate;
90		-	3. "Rebate" means a refund, discount, or other price concession
91		-	that is paid by a pharmaceutica l manufacturer to a pharmacy benefit
92		-	manager based on a prescription drug's utilization or effectiveness.
93		-	Rebate does not include an admi nistrative fee.
94		-	C. For the purpose of the insulin discount program only, the
95		-	program shall allow participants to purchase insul in at a
96		-	discounted, post-rebate rate.
97		-	D. The discount program described in this section shall:
98		-	1. Provide a participant with a n electronic document that
99		-	identifies the participant as eligible for the discount;
100		-	2. Provide a participant with information a bout pharmacies that
101		-	will honor the discount;
102		-	3. Allow a participant to purchase insulin at a discounted,
103		-	post-rebate rate; and
104		-	4. Provide a participant with instructions to pursue a
105		-	reimbursement of the purchase price from the participant 's health
106		-	insurer.
107		-	E. The discount program shall charge a p rice for the insulin
108		-	that allows the program to retain only enough of any rebate fo r the
	94	+	health care provider leg ally authorized to prescribe under the laws
	95	+	of this state:
	96	+	a. blood glucose monitors,
	97	+	b. blood glucose monitors to the legally blind,
	98	+	c. test strips for glucose monitors,
	99	+	d. visual reading and urine testing strips,
	100	+	e. insulin,
	101	+	f. injection aids,
	102	+	g. cartridges for the legally blind,
	103	+	h. syringes,
	104	+	i. insulin pumps and appurtenances theret o,
	105	+	j. insulin infusion devices,
	106	+	k. oral agents for controlling blood sugar, and
	107	+	l. podiatric appliances for pr evention of complications
	108	+	associated with diabetes.
	109	+	2. The State Board of Health shall develop and annually update,
	110	+	by rule, a list of additional diabetes equipment, related supplies
	111	+	and health care provider servi ces that are medically necessary for
	112	+	the treatment of diabetes, for which c overage shall also be
	113	+	included, subject to the terms of the policy, contract, or
	114	+	agreement, if the equipment and supplies have been approved by the
	115	+	federal Food and Drug Administrat ion (FDA). Additional FDA-approved
	116	+	diabetes equipment and related supplies , and health care provider
	117	+	services shall be determined in consultation with a national
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110		-	ENGR. H. B. NO. 2351 Page 3 1
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	145	+	diabetes association affi liated with this state, and at least three
	146	+	(3) medical directors of health benefit plans, to be selected by th e
	147	+	State Department of Health.
	148	+	3. All policies specified in this section shall also include
	149	+	coverage for:
	150	+	a. podiatric health care provider servic es as are deemed
	151	+	medically necessary to prevent complications from
	152	+	diabetes, and
	153	+	b. diabetes self-management training. As used in this
	154	+	subparagraph, "diabetes self-management training"
	155	+	means instruction in an inpatient or outpatient
	156	+	setting which enables diabetic patients to understand
	157	+	the diabetic management process and daily management
	158	+	of diabetic therapy as a method of avoiding frequent
	159	+	hospitalizations and complications. Diabetes self-
	160	+	management training shall comply with standards
	161	+	developed by the State Board of Health in consultation
	162	+	with a national diabetes associa tion affiliated with
	163	+	this state and at lea st three medical directors of
	164	+	health benefit plans selected by th e State Department
	165	+	of Health. Coverage for diabetes self-management
	166	+	training, including medical nutrition therapy relating
	167	+	to diet, caloric intake, and diabetes management, but
	168	+
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	195	+	excluding programs the only purpose of which a re
	196	+	weight reduction, shall be li mited to the following:
	197	+	(1) visits medically necessary upon the diagnosis of
	198	+	diabetes,
	199	+	(2) a physician diagnosis which represents a
	200	+	significant change in the symptoms or condition
	201	+	of the patient making medically necessary ch anges
	202	+	in the self-management of the patient, and
	203	+	(3) visits when reeducation or refresher training is
	204	+	medically necessary;
	205	+	provided, however, payment for the coverage required for d iabetes
	206	+	self-management training pursuant to the provisions of this section
	207	+	shall be required only upon cer tification by the health care
	208	+	provider providing the training that the patient ha s successfully
	209	+	completed diabetes self -management training.
	210	+	4. Diabetes self-management training shall be sup ervised by a
	211	+	licensed physician o r other licensed health care pr ovider legally
	212	+	authorized to prescribe under the laws of this state. Diabetes
	213	+	self-management training may be provided by the physician or other
	214	+	appropriately registered, certified, or licens ed health care
	215	+	professional as part of an office visit for diabe tes diagnosis or
	216	+	treatment. Training provided by appropriately registered,
	217	+	certified, or licensed health care professionals may be provided in
	218	+	group settings where practicable.
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	246	+	5. Coverage for diabetes self-management training and training
	247	+	related to medical nutrition therapy, when provided by a registered,
	248	+	certified, or licensed heal th care professional, shall also include
	249	+	home visits when medically necessary and shall include instruction
	250	+	in medical nutrition therapy only b y a licensed registered dietic ian
	251	+	or licensed certified nutritionist when authorized by the
	252	+	supervising physician of the patient when medically necessary.
	253	+	6. Coverage may be subjec t to the same annual deductibles or
	254	+	coinsurance as may be deemed appropriat e and as are consistent with
	255	+	those established for other covered benefits within a given policy.
	256	+	7. Any health benefit plan, as defined pursuant to Section
	257	+	6060.4 of this title, that provides coverage for insulin pursuant to
	258	+	this section shall cap the t otal amount that a cov ered person is
	259	+	required to pay for insulin at an amount not to exceed Thirty
	260	+	Dollars ($30.00) per thirty-day supply or Ninety Dollars ($90.00)
	261	+	per ninety-day supply of insulin for each covered insulin
	262	+	prescription, regardless of the a mount or type of insul in needed to
	263	+	fill the prescription or prescriptions of the covered person.
	264	+	a. Nothing in this paragraph shall prev ent a health
	265	+	benefit plan from reducing the cos t-sharing of a
	266	+	covered person to an amount less than Thirty Dolla rs
	267	+	($30.00) per thirty-day supply or Ninety Dollars
	268	+	($90.00) per ninety-day supply.
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	296	+	b. The Insurance Commissioner shall ens ure all health
	297	+	benefit plans comply with the requirements of this
	298	+	paragraph.
	299	+	c. The Commissioner may promulgat e rules as necessary to
	300	+	implement and administer the requirements of this
	301	+	paragraph and to align with federal requirements.
	302	+	B. 1. Health benefit plans shall not reduce or eliminate
	303	+	coverage due to the requirement s of this section.
	304	+	2. Enforcement of the provisions of this act shall be performed
	305	+	by the Insurance Department and the State Department of Health.
	306	+	C. As used in this section, "health benefit plan" means any
	307	+	plan or arrangement as d efined in subsection C of Section 6060.4 of
	308	+	this title.
	309	+	SECTION 2. NEW LAW A new section of law to be codified
	310	+	in the Oklahoma Statutes as Section 6060.2a of Title 36, unless
	311	+	there is created a duplication in numbering, reads as follows:
	312	+	A. The State shall direct the creation of a discount progr am
	313	+	that will allow participants t o purchase insulin at a discounted,
	314	+	post-rebate rate.
	315	+	B. As used in this section , unless the context otherwise
	316	+	requires:
	317	+	1. "Participant" means a resident of Oklahoma who:
	318	+	a. uses insulin to treat diabetes,
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	320	+	HB2351 HFLR Page 7
	321	+	BOLD FACE denotes Committee Amen dments. 1
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	346	+	b. does not receive health coverage un der the program,
	347	+	and
	348	+	c. enrolls in the discount program;
	349	+	2. "Discount program" means a process developed by the program
	350	+	that allows participants to purchase insulin at a discounted, post -
	351	+	rebate rate;
	352	+	3. "Rebate" means a refund, discount or other price concession
	353	+	that is paid by a pharmaceutica l manufacturer to a pharmacy benefit
	354	+	manager based on a prescription drug's utilization or effectiveness.
	355	+	"Rebate" does not include an administrative fee.
	356	+	C. For the purpose of the insulin discount program only, the
	357	+	program shall allow participants to purchase insul in at a
	358	+	discounted, post-rebate rate.
	359	+	D. The discount program described in this section shall:
	360	+	1. Provide a participant with an electroni c document that
	361	+	identifies the participant as eligible for the discount;
	362	+	2. Provide a participant with information a bout pharmacies that
	363	+	will honor the discount;
	364	+	3. Allow a participant to purchase insulin at a discounted,
	365	+	post-rebate rate; and
	366	+	4. Provide a participant with instructions to pursue a
	367	+	reimbursement of the purchase price from the participant 's health
	368	+	insurer.
	369	+
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	396	+	E. The discount program shall charge a p rice for the insulin
	397	+	that allows the program to retain only enough of any rebate for the
135	398		insulin to make the state risk pool whole for providing discounted
136	399		insulin to participants.
137		-	SECTION 2. This act shall become effective November 1, 2023.
138		-	Passed the House of Representatives the 14th day of March, 2023.
	400	+	SECTION 3. This act shall become effective November 1, 2023.
139	401
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141		-
142		-
143		-	Presiding Officer of the House
144		-	of Representatives
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147		-
148		-	Passed the Senate the ____ day of __________, 2023.
149		-
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152		-
153		-	Presiding Officer of the Senate
154		-
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	402	+	COMMITTEE REPORT BY: COMMITTEE ON INSURANCE, dated 02/28/2023 - DO
	403	+	PASS.