Revised Code of Washington
Chapter 41.05 - State Health Care Authority.
41.05.765 - Insulin drugs—Cap on enrollee's required payment amount—Cost-sharing requirements.

RCW 41.05.765
Insulin drugs—Cap on enrollee's required payment amount—Cost-sharing requirements. (Expires January 1, 2023.)

(1) Except as required in subsection (2) of this section, a health plan offered to public employees and their covered dependents under this chapter that is issued or renewed by the board on or after January 1, 2021, that provides coverage for prescription insulin drugs for the treatment of diabetes must cap the total amount that an enrollee is required to pay for a covered insulin drug at an amount not to exceed one hundred dollars per thirty-day supply of the drug. Prescription insulin drugs must be covered without being subject to a deductible, and any cost sharing paid by an enrollee must be applied toward the enrollee's deductible obligation.
(2) If the federal internal revenue service removes insulin from the list of preventive care services which can be covered by a qualifying health plan for a health savings account before the deductible is satisfied, for a health plan that provides coverage for prescription insulin drugs for the treatment of diabetes and is offered as a qualifying health plan for a health savings account, the health plan offered under this chapter must establish the plan's cost sharing for the coverage of prescription insulin for diabetes at the minimum level necessary to preserve the enrollee's ability to claim tax exempt contributions from his or her health savings account under internal revenue service laws and regulations. The office of the insurance commissioner must provide written notice of the change in internal revenue service guidance to affected parties, the chief clerk of the house of representatives, the secretary of the senate, the office of the code reviser, and others as deemed appropriate by the office.
(3) The authority must monitor the wholesale acquisition cost of all insulin products sold in the state.
(4) This section expires January 1, 2023.

[ 2020 c 245 § 2.]

Structure Revised Code of Washington

Revised Code of Washington

Title 41 - Public Employment, Civil Service, and Pensions

Chapter 41.05 - State Health Care Authority.

41.05.004 - Intent—Use of word "board."

41.05.006 - Purpose.

41.05.008 - Duties of employing agencies.

41.05.009 - Determination of employee or school employee eligibility for benefits.

41.05.0091 - Eligibility exists prior to January 1, 2010.

41.05.011 - Definitions.

41.05.013 - State purchased health care programs—Uniform policies—Report to the legislature.

41.05.014 - Applications, enrollment forms, and eligibility certification documents—Signatures.

41.05.015 - Medical director—Appointment of personnel.

41.05.017 - Provisions applicable to health plans offered under this chapter.

41.05.018 - Transfer of certain behavioral health-related powers, duties, and functions from the department of social and health services.

41.05.021 - State health care authority—Director—Cost control and delivery strategies—Health information technology—Managed competition—Rules.

41.05.022 - State agent for purchasing health services—Single community-rated risk pool.

41.05.023 - Chronic care management program—Uniform medical plan—Definitions.

41.05.026 - Contracts—Proprietary data, trade secrets, actuarial formulas, statistics, cost and utilization data—Exemption from public inspection—Executive sessions.

41.05.031 - Agencies to establish health care information systems.

41.05.033 - Shared decision-making demonstration project—Preference-sensitive care.

41.05.035 - Exchange of health information—Pilot—Advisory board, discretionary—Administrator's authority.

41.05.036 - Health information—Definitions.

41.05.037 - Nurse hotline, when funded.

41.05.039 - Health information—Secure access—Lead organization—Administrator's duties.

41.05.042 - Health information—Processes, guidelines, and standards.

41.05.046 - Health information—Conflict with federal requirements.

41.05.050 - Contributions for employees and dependents—Definitions.

41.05.055 - Public employees' benefits board—Members.

41.05.065 - Public employees' benefits board—Duties—Eligibility—Definitions—Penalties.

41.05.066 - Domestic partner benefits.

41.05.068 - Federal employer incentive program—Authority to participate.

41.05.074 - Public employees—Prior authorization standards and criteria—Health plan requirements—Definitions.

41.05.075 - Employee benefit plans—Contracts with insuring entities—Performance measures—Financial incentives—Health information technology.

41.05.080 - Participation in insurance plans and contracts—Retired, disabled, or separated employees—Certain surviving spouses, state registered domestic partners, and dependent children.

41.05.085 - Retired state employee and retired or disabled school employee health insurance subsidy.

41.05.090 - Continuation of coverage of employee, spouse, or covered dependent ineligible under state plan—Exceptions.

41.05.095 - Coverage for dependents under the age of twenty-six.

41.05.100 - Chapter not applicable to certain employees of Cooperative Extension Service.

41.05.110 - Chapter not applicable to officers and employees of state convention and trade center.

41.05.120 - Public employees' and retirees' insurance account—School employees' insurance account.

41.05.123 - Flexible spending administrative account—Salary reduction account—School employees' benefits board flexible spending and dependent care administrative account—School employees' benefits board salary reduction account.

41.05.130 - State health care authority administrative account—School employees' insurance administrative account.

41.05.140 - Payment of claims—Self-insurance—Insurance reserve fund created.

41.05.143 - Uniform medical plan benefits administration account—Uniform dental plan benefits administration account—School employees' benefits board medical benefits administrative account—School employees' benefits board dental benefits administrat...

41.05.160 - Rules.

41.05.165 - Rules—Insurance benefit reimbursement.

41.05.170 - Neurodevelopmental therapies—Employer-sponsored group contracts.

41.05.175 - Prescribed, self-administered anticancer medication.

41.05.177 - Prostate cancer screening—Required coverage.

41.05.180 - Mammograms—Insurance coverage.

41.05.183 - General anesthesia services for dental procedures—Public employee benefit plans.

41.05.185 - Diabetes benefits—State purchased health care.

41.05.188 - Eosinophilic gastrointestinal associated disorder—Elemental formula.

41.05.195 - Medicare supplemental insurance policies.

41.05.197 - Medicare supplemental insurance policies.

41.05.205 - Tricare supplemental insurance policy—Authority to offer—Rules.

41.05.220 - Community and migrant health centers—Maternity health care centers—People of color—Underserved populations.

41.05.225 - Blind licensees in the business enterprises program—Plan of health insurance.

41.05.240 - American Indian health care delivery plan.

41.05.280 - Department of corrections—Inmate health care.

41.05.295 - Dependent care assistance program—Health care authority—Powers, duties, and functions.

41.05.300 - Salary reduction agreements—Authorized.

41.05.310 - Salary reduction plan—Policies and procedures—Plan document.

41.05.320 - Salary reduction plan—Eligibility—Participation, withdrawal.

41.05.330 - Salary reduction plan—Accounts and records.

41.05.340 - Salary reduction plan—Termination—Amendment.

41.05.350 - Salary reduction plan—Rules.

41.05.360 - Salary reduction plan—Construction.

41.05.400 - Plan of health care coverage—Available funds—Components—Eligibility—Administrator's duties.

41.05.405 - Public option plans—Availability—Hospital contracts—Recommendations.

41.05.410 - Qualified health plans—Contract for—Requirements—Cost and quality data.

41.05.413 - Qualified health plans—Reimbursement limit—Waiver.

41.05.420 - Plan of health care coverage—Prescription insulin drug cost limits—Cost sharing.

41.05.430 - Plan of health care coverage—Immediate postpartum contraception devices.

41.05.520 - Pharmacy connection program—Notice.

41.05.525 - Treatment of opioid use disorder—Prior authorization.

41.05.526 - Withdrawal management services—Substance use disorder treatment services—Prior authorization—Utilization review—Medical necessity review.

41.05.527 - Opioid overdose reversal medication bulk purchasing and distribution program.

41.05.528 - Standard set of criteria—Medical necessity for substance use disorder treatment—Substance use disorder levels of care—Rules.

41.05.530 - Prescription drug assistance, education—Rules.

41.05.533 - Medication synchronization policy required for health benefit plans covering prescription drugs—Requirements—Definitions.

41.05.540 - State employee health program—Requirements—Report.

41.05.550 - Prescription drug assistance foundation—Nonprofit and tax-exempt corporation—Definitions—Liability.

41.05.600 - Mental health services—Definition—Coverage required, when.

41.05.601 - Mental health services—Rules.

41.05.630 - Annual report of customer service complaints and appeals.

41.05.650 - Community health care collaborative grant program—Grants—Administrative support—Eligibility.

41.05.651 - Rules—2009 c 299.

41.05.660 - Community health care collaborative grant program—Award and disbursement of grants.

41.05.670 - Chronic care management incentives—Provider reimbursement methods.

41.05.680 - Report—Chronic care management.

41.05.690 - Performance measures committee—Membership—Selection of performance measures—Benchmarks for purchasing decisions—Public process for evaluation of measures.

41.05.700 - Reimbursement of health care services provided through telemedicine or store and forward technology—Audio-only telemedicine.

41.05.730 - Ground emergency medical transportation services—Medicaid reimbursement—Calculation—Federal approval—Department's duties.

41.05.735 - Ground emergency medical transportation services—Medicaid reimbursement—Intergovernmental transfer program—Federal approval—Authority's duties.

41.05.740 - School employees' benefits board.

41.05.742 - Single enrollment requirement.

41.05.744 - School employee eligibility during COVID-19 state of emergency.

41.05.745 - School employees' benefits board—Employee-paid, voluntary benefits—Optional benefits.

41.05.750 - Problem and pathological gambling treatment program.

41.05.751 - Problem gambling account.

41.05.760 - Recovery residences—Registry.

41.05.761 - Recovery residences—Technical assistance for residences seeking certification.

41.05.762 - Recovery residences—Revolving fund.

41.05.765 - Insulin drugs—Cap on enrollee's required payment amount—Cost-sharing requirements.

41.05.820 - Qualified requirement for health carrier in insurance holding company to offer silver and gold health plans.

41.05.830 - Coverage for hearing instruments—Definitions.

41.05.840 - Universal health care commission.

41.05.890 - Certain health care and financial related data provided to authority—Exempt from disclosure.

41.05.900 - Short title.

41.05.901 - Implementation—Effective dates—1988 c 107.