September 28, 2021
On September 14, 2021, Commissioner Mulready issued LH Bulletin No. 2021-04. The bulletin provides guidance on a provision of HB 1019, which will be effective November 1, 2021, that places a cap on the amount a policyholder must pay out of pocket for insulin. Under the new law, issuers in the state must cap the amount a policyholder must pay at a maximum of $30.00 per 30-day supply or $90.00 per 90-day supply of insulin for each covered insulin prescription, regardless of the amount or type of insulin needed to fill the prescription or prescriptions of the covered person.
The bulletin makes clear that this cap applies to all existing health plans, as well as those that renew or are issued after the effective date. In addition, the guidance states that the cap shall apply regardless of whether the policyholder has met the annual deductible or coinsurance requirements within a given policy. However, the bulletin clarifies that the cap applies separately for each prescription of insulin. For example, if the policyholder has two prescriptions, then they would be required to pay a maximum of $60.00 per 30-day supply ($30.00 x 2).
Employers with plans regulated by the state should be aware of these developments.
HB 1019 » LH Bulletin No. 2021-04 »