RCW 48.43.780
Insulin drugs—Cap on enrollee's required payment amount—Cost-sharing requirements. (Effective until January 1, 2023.)
(1) Except as required in subsection (2) of this section, a health plan issued or renewed 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 carrier 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) This section expires January 1, 2023.
[ 2020 c 346 § 5; 2020 c 245 § 1.]
NOTES:
Reviser's note: This section was amended by 2020 c 245 § 1 and by 2020 c 346 § 5, each without reference to the other. Both amendments are incorporated in the publication of this section under RCW 1.12.025(2). For rule of construction, see RCW 1.12.025(1).
Intent—2020 c 346: See note following RCW 70.14.165.
(1) Except as required in subsection (2) of this section, a health plan issued or renewed on or after January 1, 2023, 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 $35 per 30-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 carrier 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) This section expires January 1, 2024.
[ 2022 c 10 § 1. Prior: 2020 c 346 § 5; 2020 c 245 § 1.]
NOTES:
Effective date—2022 c 10 § 1: "Section 1 of this act takes effect January 1, 2023." [ 2022 c 10 § 3.]
Intent—2020 c 346: See note following RCW 70.14.165.
Structure Revised Code of Washington
Chapter 48.43 - Insurance Reform.
48.43.008 - Enrollment in employer-sponsored health plan—Person eligible for medical assistance.
48.43.009 - Health care sharing ministries.
48.43.012 - Health plans—Preexisting conditions—Rules.
48.43.01211 - Health plans—Eligibility—Health status-related factors—Rules.
48.43.0123 - Health plans—Rescission of coverage—Rules.
48.43.0124 - Health plans—Cost sharing for essential health benefits—Rules.
48.43.0125 - Essential health benefits—Annual or lifetime dollar limits.
48.43.0127 - Group health plans—Waiting period—Rules.
48.43.016 - Utilization management standards and criteria—Health carrier requirements—Definitions.
48.43.021 - Personally identifiable health information—Restrictions on release.
48.43.022 - Enrollee identification card—Social security number restriction.
48.43.023 - Pharmacy identification cards—Rules.
48.43.028 - Eligibility to purchase certain health benefit plans—Small employers and small groups.
48.43.035 - Group health benefit plans—Guaranteed issue and continuity of coverage—Exceptions.
48.43.038 - Individual health plans—Guarantee of continuity of coverage—Exceptions.
48.43.041 - Individual health benefit plans—Mandatory benefits.
48.43.043 - Colorectal cancer examinations and laboratory tests—Required benefits or coverage.
48.43.045 - Health plan requirements—Annual reports—Exemptions.
48.43.047 - Health plans—Minimum coverage for preventative services—No cost-sharing requirements.
48.43.055 - Procedures for review and adjudication of health care provider complaints—Requirements.
48.43.059 - Payments made by a second-party payment process—Definition.
48.43.0725 - Reproductive health plan coverage—Immediate postpartum contraception devices.
48.43.073 - Required abortion coverage—Limitations.
48.43.081 - Anatomic pathology services—Payment for services—Definitions.
48.43.083 - Chiropractor services—Participating provider agreement—Health carrier reimbursement.
48.43.091 - Health carrier coverage of outpatient mental health services—Requirements.
48.43.093 - Health carrier coverage of emergency medical services—Requirements—Conditions.
48.43.094 - Pharmacist provided services—Health plan requirements.
48.43.097 - Filing of financial statements—Every health carrier.
48.43.105 - Preparation of documents that compare health carriers—Immunity—Due diligence.
48.43.125 - Coverage at a long-term care facility following hospitalization—Definition.
48.43.176 - Eosinophilic gastrointestinal associated disorder—Elemental formula.
48.43.180 - Denturist services.
48.43.185 - General anesthesia services for dental procedures.
48.43.190 - Payment of chiropractic services—Parity.
48.43.195 - Contraceptive drugs—Twelve-month refill coverage.
48.43.200 - Disclosure of certain material transactions—Report—Information is confidential.
48.43.205 - Material acquisitions or dispositions.
48.43.210 - Asset acquisitions—Asset dispositions.
48.43.215 - Report of a material acquisition or disposition of assets—Information required.
48.43.220 - Material nonrenewals, cancellations, or revisions of ceded reinsurance agreements.
48.43.600 - Overpayment recovery—Carrier.
48.43.605 - Overpayment recovery—Health care provider.
48.43.650 - Fixed payment insurance products—Commissioner's annual report.
48.43.670 - Plan or contract renewal—Modification of wellness program.
48.43.680 - Lifetime limit on transplants—Definition.
48.43.690 - Assessments under RCW 70.290.040 considered medical expenses.
48.43.700 - Exchange—Plans that a carrier must offer—Review—Rules.
48.43.705 - Plans offered outside of exchange.
48.43.710 - Certification as qualified health plan not an exemption.
48.43.720 - Reinsurance and risk adjustment programs—Affordable care act—Rules.
48.43.733 - Rates and forms of group health benefit plans—Timing of filings—Exceptions—Rules.
48.43.734 - Health carrier rate filings—Review of surplus, capital, and profit levels.
48.43.740 - Dental only plan—Emergency dental conditions—Definitions.
48.43.743 - Dental only plan—Annual data statement—Contents—Public use—Definition.
48.43.755 - Health care provider credentialing applications—Use of electronic database by providers.
48.43.757 - Health care provider credentialing applications—Reimbursement requirements.
48.43.760 - Opioid use disorder—Coverage without prior authorization.
48.43.762 - Opioid overdose reversal medication bulk purchasing and distribution program.
48.43.765 - Health carrier network adequacy—Mental health and substance abuse treatment.
48.43.770 - Individual market health plan availability—Annual report.
48.43.775 - Qualified health plan participation—Reimbursement rate for other health plans.
48.43.780 - Insulin drugs—Cap on enrollee's required payment amount—Cost-sharing requirements.
48.43.785 - COVID-19 personal protective equipment expenses—Health care provider reimbursement.
48.43.790 - Behavioral services—Next-day appointments.
48.43.795 - Qualified health plans—Acceptance of premium and cost-sharing assistance.
48.43.800 - Primary care expenditures assessment—Review.
48.43.805 - Prescription drug upper payment limit—Rules.
48.43.810 - Biomarker testing—Standards—Construction.
48.43.815 - Donor human milk—Standards.
48.43.820 - Consolidated appropriations act enforcement—Implementation of federal regulations.
48.43.320 - Authorized control level event—Commissioner's options.
48.43.325 - Mandatory control level event—Commissioner's duty—Regulatory control.
48.43.330 - Carrier's right to hearing—Request by carrier—Date set by commissioner.
48.43.340 - Powers or duties of commissioner not limited—Rules.
48.43.350 - No liability or cause of action against commissioner or department.
48.43.355 - Notice by commissioner to carrier—When effective.
48.43.360 - Initial RBC reports—Calculation of initial RBC levels—Subsequent reports.
48.43.366 - Self-funded multiple employer welfare arrangements.
48.43.370 - RBC standards not applicable to certain carriers.
48.43.400 - Prescription drug utilization management—Definitions.
48.43.430 - Prescription medication—Maximum charge at point of sale—Requirements.
48.43.435 - Prescription medication—Cost-sharing calculation—Application—Rules.
48.43.500 - Intent—Purpose—2000 c 5.
48.43.515 - Access to appropriate health services—Enrollee options—Rules.
48.43.525 - Prohibition against retrospective denial of health plan coverage—Rules.
48.43.540 - Requirement to designate a licensed medical director—Exemption.
48.43.545 - Standard of care—Liability—Causes of action—Defense—Exception.
48.43.550 - Delegation of duties—Carrier accountability.
48.43.902 - Effective date—1996 c 312.
48.43.904 - Construction—Chapter applicable to state registered domestic partnerships—2009 c 521.