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Clarification Regarding Cost-Sharing for Insulin Drugs


On August 8, 2022, Insurance Commissioner McVey issued Bulletin 2022-09, which provides clarification related to the maximum cost-sharing that may be charged to a covered participant for insulin drugs. Existing law prohibits health insurance policies from charging a participant more than $100 cost-sharing per 30-day period for insulin drugs. Some insurers interpreted this to mean $100 per insulin drug category. For example, if a participant was prescribed both rapid-acting insulin and short-acting insulin during a 30-day period, the insurer was imposing $100 cost-sharing for each category for a total of $200. The bulletin clarifies that the maximum $100 cost-sharing applies to all combined insulin drug categories. In other words, in the above example, the participant could only be charged a $100 cost-sharing for both prescription categories combined.

As this is an interpretation of an existing law, it is considered effective immediately. Employer plan sponsors should be aware of the change in coverage and work with insurers to revise plan documents as necessary.

Bulletin 2022-09 »