Relating to a limit on cost-sharing requirements imposed by a health benefit plan for certain prescription insulin.
The legislation will primarily affect health benefit plans issued or renewed from January 1, 2022, onwards. It applies to various types of coverage including individual and group insurance policies, as well as school district group health coverage. By providing these protections, SB76 aims to decrease out-of-pocket expenses for individuals with diabetes, ultimately promoting better health management and potentially reducing the risk of severe health complications associated with diabetes. Coverage provided under the Child Health Plan and Medical Assistance Programs will also be included, expanding the reach of these cost-containment measures.
Senate Bill 76 (SB76) aims to limit the cost-sharing requirements imposed by health benefit plans for certain prescription insulin medications. Specifically, the bill mandates that a health benefit plan cannot require an enrollee to pay more than $100 for a 30-day supply of insulin. This provision is intended to make insulin more affordable for those who rely on it to manage diabetes, a condition that affects millions of Americans. Additionally, the bill states that this $100 limit will be adjusted annually based on increases in the Consumer Price Index for medical care, thus ensuring that the cap remains relevant over time.
While the bill has garnered support for its intent to alleviate the financial burden on individuals dependent on insulin, discussions surrounding its implementation may raise concerns from stakeholders in the insurance industry. Some may argue that the reduced cost-sharing requirement could affect premiums or the overall cost structure of health plans. Additionally, there may be debates regarding the types of insurance plans exempt from these provisions, including those that provide supplemental benefits or coverage for specific diseases. This could lead to discussions about the balance between ensuring affordability and maintaining a sustainable insurance market.