Insulin copayment or coinsurance limitation.
Effective Sep 21, 2022April 7, 2017, D.C. Law 21-248, § 3a; Mar. 16, 2021, D.C. Law 23-252, § 2(d); Sept. 21, 2022, D.C. Law 24-170, § 5
- (a) A health insurer that provides coverage for prescription insulin drugs pursuant to the terms of a health benefits plan the insurer offers shall limit the total amount that an insured is required to pay for a 30-day supply of covered prescription insulin drugs at an amount not to exceed $30, regardless of the quantity or type of covered prescription insulin drug used to fill the insured's prescription.
- (b) A health insurer that provides coverage for diabetes devices and diabetic ketoacidosis devices pursuant to the terms of a health benefits plan offered by the insurer, shall limit the total amount that an insured is required to pay for a 30-day supply of all medically necessary covered diabetes devices and diabetic ketoacidosis devices that are in accordance with the insured's diabetes treatment plan at an amount not to exceed $100.
- (c) Pursuant to subsections (a) and (b) of this section, prescription insulin drugs, diabetes devices, and diabetic ketoacidosis devices shall be covered without being subject to a deductible and any cost sharing paid by an insured shall be applied toward the insured's deductible and out of pocket maximum obligations.
- (d) Nothing in this section prevents an insurer from reducing an insured's copayment or coinsurance by an amount greater than the amount specified in subsections (a) and (b) of this section.
- (e) On July 1 of each year, the limit on a required copayment or coinsurance an insured is required to pay under subsections (a) and (b) of this section shall increase by a percentage equal to the percentage change from the preceding year in the medical care component of the Consumer Price Index for All Urban Consumers, Washington-Arlington-Alexandria, DC-VA-MD-WV metropolitan area, as published by the Bureau of Labor Statistics of the United States Department of Labor.
- (f) This section shall apply as of January 1, 2022.
History
April 7, 2017, D.C. Law 21-248, § 3a
Mar. 16, 2021, D.C. Law 23-252, § 2(d)
Sept. 21, 2022, D.C. Law 24-170, § 5