HB 263: Cap cost sharing for prescription insulin drugs, diabetes devices

Cosponsors: Representatives Brennan, Troy, Synenberg, McNally, Sweeney, Rader, Baker, Cockley, Grim, White, E., Hall, D., Piccolantonio, Brewer, Brent, Somani, Sims, Miller, J., Brownlee, Mohamed, Lett, Isaacsohn

To enact section 3902.65 of the Revised Code to cap cost sharing for prescription insulin drugs, diabetes devices, and diabetic ketoacidosis devices.

Section 1.

That section 3902.65 of the Revised Code be enacted to read as follows:

Sec. 3902.65. (A) As used in this section:

1. "Prescription insulin drug" means a prescription drug that contains insulin and is used to treat diabetes;
2. "Diabetes device" means a blood glucose test strip, continuous glucose monitor, lancet, lancing device, insulin syringe, insulin pump, or other device used to cure, diagnose, mitigate, prevent, or treat diabetes or low blood sugar, regardless of whether a prescription is required to dispense the device.
3. "Diabetic ketoacidosis device" means a device that is used to screen for or prevent diabetic ketoacidosis, regardless of whether a prescription is required to dispense the device.

(B) Notwithstanding section 3901.71 of the Revised Code, no health plan issuer that provides coverage for prescription insulin drugs, diabetes devices, or diabetic ketoacidosis devices pursuant to the terms of a health benefit plan amended, issued, or renewed on or after the effective date of this section shall require cost sharing in excess of either of the following:

1. Thirty-five dollars in aggregate for a thirty-day supply of all covered prescription insulin drugs prescribed for the covered person, regardless of the amount or type of insulin needed to fill the covered person's prescription;
2. Thirty-five dollars in aggregate for a thirty-day supply of all covered diabetes devices or diabetic ketoacidosis devices used by the covered person.

(C) The cost-sharing limitations prescribed by division (B) of this section apply regardless of any deductible, copayment, coinsurance, or any other cost-sharing requirement that would otherwise apply to the covered person under the health benefit plan.

(D) This section does not prohibit a health plan issuer from reducing a covered person's cost-sharing requirement for prescription insulin drugs, diabetes devices, or diabetic ketoacidosis devices to amounts less than those prescribed by division (B) of this section.