October 18, 2016

On Oct. 3, 2016, the Puerto Rico Office of the Commissioner of Insurance issued Ruling Letter No.: CN-2016-204-AS, which implements the necessary guidelines for Public Law No. 177-2016 (the “Law”) passed on Aug. 13, 2016.

As background, the Law requires that all insurers and health services organizations include as part of basic coverage in private health insurance a glucose monitor to be provided every three years and a minimum of 150 strips and 150 lancets a month for patients under 21 years old who have been diagnosed with Diabetes Mellitus Type I by a specialist in pediatric endocrinology or endocrinology. The ruling letter states that this coverage will also be available if the specialist in endocrinology orders it for patients under 21 years old whose condition shows a predisposition or a significant number of risk factors for developing Diabetes Mellitus Type I. Once diagnosed, patients must submit a prescription issued by a physician who is authorized to exercise the profession within the jurisdiction of the Commonwealth of Puerto Rico so that the pharmacist may dispense the monthly strips and lancets.

In addition, the Law mandates including as part of basic health insurance coverage, a portable insulin pump as therapy for patients under 21 years old who have been diagnosed with Diabetes Mellitus Type I, and who meet certain criteria. The ruling letter states that the qualification criteria established in Section 2 of the Law, will be deemed to have been amended so that they will be aligned with the guidelines of CMS, or any other law, federal regulation or administrative guideline that modifies or eliminates the current qualification criteria for the use of insulin pumps that are applicable to Puerto Rico.

Insurers and health services organizations that write private health insurance in Puerto Rico are required to take the necessary steps to bring policies into compliance with the Law and this ruling letter for policy years beginning on or after Jan. 1, 2017.

Ruling Letter No.: CN-2016-204-AS »