Bill Text: VA HB760 | 2024 | Regular Session | Prefiled
Bill Title: Health insurance; cost-sharing payments for insulin and diabetes equipment and supplies.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced - Dead) 2024-02-13 - Left in Labor and Commerce [HB760 Detail]
Download: Virginia-2024-HB760-Prefiled.html
Be it enacted by the General Assembly of Virginia:
1. That §§38.2-3407.15:5 and 38.2-3418.10 of the Code of Virginia are amended and reenacted as follows:
§38.2-3407.15:5. Limit on cost-sharing payments for prescription insulin drugs.
A. As used in this section:
"Carrier" has the same meaning ascribed thereto in subsection A of §38.2-3407.15.
"Cost-sharing payment" means the total amount a covered person is required to pay at the point of sale in order to receive a prescription drug that is covered under the covered person's health plan.
"Covered person" means a policyholder, subscriber, participant, or other individual covered by a health plan.
"Health plan" means any health benefit plan, as defined in §38.2-3438, that provides coverage for a prescription insulin drug.
"Pharmacy benefits manager" means an entity that engages in the administration or management of prescription drug benefits provided by a carrier for the benefit of its covered persons.
"Prescription insulin drug" means a prescription drug that contains insulin and is used to treat diabetes.
"Provider contract" has the same meaning ascribed thereto in subsection A of §38.2-3407.15.
B. Every health plan offered by a carrier shall set the
cost-sharing payment that a covered person is required to pay for a covered
prescription insulin drug at an amount that does not exceed
$50 $35
in aggregate, including situations where the covered person is prescribed more
than one insulin drug, per 30-day supply of the
prescription insulin drug, regardless of the amount or type of insulin needed
to fill the covered person's prescription.
C. Nothing in this section shall prevent a carrier from setting a covered person's cost-sharing payment for a covered prescription insulin drug at an amount that is less than the maximum amount permitted pursuant to subsection B.
D. No provider contract between a carrier or its pharmacy benefits manager and a pharmacy or its contracting agent shall contain a provision (i) authorizing the carrier's pharmacy benefits manager or the pharmacy to charge, (ii) requiring the pharmacy to collect, or (iii) requiring a covered person to make a cost-sharing payment for a covered prescription insulin drug in an amount that exceeds the amount of the cost-sharing payment for the covered prescription insulin drug established by the carrier pursuant to subsection B.
E. This section shall apply with respect to health plans and provider contracts entered into, amended, extended, or renewed on or after January 1, 2021.
F. Pursuant to the authority granted by §38.2-223, the Commission may adopt such rules and regulations as it may deem necessary to implement this section.
§38.2-3418.10. Coverage for diabetes.
A. As used in this section:
"Cost-sharing payment" means the total amount a covered person is required to pay at the point of sale in order to receive equipment and supplies that are covered under the covered person's policy, contract, or plan.
"Equipment and supplies" means blood glucose meters and strips, urine-testing strips, syringes, continuous glucose monitors and supplies, and insulin pump supplies. "Equipment and supplies" shall not be considered durable medical equipment.
B. Each insurer proposing to issue an individual or group hospital policy or major medical policy in this Commonwealth, each corporation proposing to issue an individual or group hospital, medical or major medical subscription contract, and each health maintenance organization providing a health care plan for health care services shall provide coverage for diabetes as provided in this section.
B. C. Such coverage shall include
benefits for equipment, and supplies and in-person
outpatient self-management training and education, including medical nutrition
therapy, for the treatment of insulin-dependent diabetes, insulin-using
diabetes, gestational diabetes and noninsulin-using diabetes if prescribed by a
health care professional legally authorized to prescribe such items under law. As used herein, the terms "equipment"
and "supplies" shall not be considered durable medical equipment.
C. D. To qualify for coverage
under this section, diabetes in-person outpatient self-management training and
education shall be provided by a certified, registered or licensed health care
professional. A managed care health insurance plan, as defined in Chapter 58 (§
38.2-5800 et seq.) of this title, may require such health care professional to
be a member of the plan's provider network; provided that such network includes
sufficient health care professionals who are qualified by specific education,
experience, and credentials to provide the covered benefits described in this
section.
D. E. No insurer, corporation, or
health maintenance organization shall impose upon any person receiving benefits
pursuant to this section any copayment, fee or condition that is not equally
imposed upon all individuals in the same benefit category, nor shall any
insurer, corporation or health maintenance organization impose any policy-year
or calendar-year dollar or durational benefit limitations or maximums for
benefits or services provided under this section.
Additionally, every policy, contract, or
plan offered by an insurer,
corporation, or health maintenance organization shall set the
cost-sharing payment that a covered person is required to pay for equipment and
supplies at an amount that does not exceed $35 in aggregate,
including situations where the covered person is prescribed more than one piece
of equipment or type of supplies, per 30-day supply
of the equipment and supplies, regardless of the amount or type of equipment
or supplies needed to fill the covered person's prescription.
E. F. The requirements of this
section shall apply to all insurance policies, contracts and plans delivered, issued
for delivery, reissued, or extended on and after July 1, 2000, or at any time
thereafter when any term of the policy, contract or plan is changed or any
premium adjustment is made.
F. G. This section shall not apply
to short-term travel, accident only, or limited or specified disease policies
or contracts, nor to policies or contracts designed for issuance to persons
eligible for coverage under Title XVIII of the Social Security Act, known as
Medicare, or any other similar coverage under state or federal governmental
plans.
2. That the provisions of this act shall apply to insurance policies, contracts, and plans delivered, issued for delivery, reissued, amended, or extended on or after January 1, 2025.
