State Interprets Statute Capping Insulin Costs

On November 29, 2021, Commissioner Mulready issued Bulletin No. LH 2021-04. This bulletin, sent to all health insurance companies and other interested parties, provides guidance regarding recent legislation that affects the amount policyholders must pay for insulin.

The state recently passed HB 1019, effective November 1, 2021, which states that the amount that a policyholder must pay for insulin is capped at $30 for a thirty-day supply and $90 for a ninety-day supply 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 states that the department’s position that the out-of-pocket monthly cap shall apply regardless of whether the policyholder has met the annual deductible or coinsurance requirements within a given policy. As of the effective date of the legislation, the caps will apply to existing health plans as well as upon issue or renewal of a benefit plan.

In addition, it is the department’s position that if a policyholder’s thirty-day supply of insulin consists of three different insulin prescriptions, then the covered policyholder shall be required to pay a maximum of $30.00 out-of-pocket for each of the three insulin prescriptions, because the caps apply to each supply regardless of the amount of type.

This cap does not apply to Medicare Part D plans.

Employers with plans regulated by the state should be aware of this development.

Bulletin No. LH 2021-04 »
HB 1019 »