Insulin cost-sharing cap. Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act’s requirements a crime. Existing law requires every health care service plan contract that covers hospital, medical, or surgical expenses to include coverage for specified equipment and supplies for the management and treatment of diabetes.
Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law requires a health an insurance policy that covers hospital, medical, or surgical expenses that is issued, amended, delivered, or renewed on or after January 1, 2000, to include coverage for specified equipment and supplies for the management and treatment of insulin-using diabetes, non-insulin-using diabetes, and gestational diabetes as medically necessary, even if the items are available without a prescription. Existing law requires a health an insurance policy issued, amended, delivered, or renewed on or after January 1, 2000, that covers prescription benefits to include coverage for specified diabetes management prescription items, including insulin and glucagon.
This bill would prohibit a health care service plan contract or a health specified disability insurance policy that is issued, amended, delivered, or renewed on or after January 1, 2021, from imposing cost sharing on a covered insulin prescription, except for a copayment not to exceed $50 per 30-day supply of insulin, and no more than $100 total per month, regardless of the amount or type of insulin. The bill would apply these cost-sharing limitations until January 1, 2024.
The bill would also authorize the Attorney General to investigate pricing of prescription insulin drugs to ensure adequate pricing protections for consumers, and would authorize the Attorney General, by November 1, 2022, to issue and make publicly available a report detailing its findings from any insulin pricing investigations. The bill would exempt trade secret or proprietary business information submitted to the Attorney General pursuant to these provisions from specified disclosure requirements. The bill would make these provisions applicable until January 1, 2024.
Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest.
This bill would make legislative findings to that effect.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.