RS 22:1034.1

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RS 22:1034.1

§1034.1. Health insurance coverage for insulin; limit on cost-sharing requirement

A. As used in this Section, the following terms apply:

(1)"Formulary" has the same meaning as the term is defined in R.S. 22:1060.1.

(2)"Health coverage plan" means any hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, contract, or other agreement with a health maintenance organization or a preferred provider organization, health and accident insurance policy, or any other insurance contract of this type in this state, including a group insurance plan, a self-insurance plan, and the Office of Group Benefits programs. "Health coverage plan" does not include a plan providing coverage for excepted benefits as defined in R.S. 22:1061, limited benefit health insurance plans, short-term policies that have a term of less than twelve months, and plans that do not provide prescription drug coverage.

(3)"Insulin" means a prescription drug that contains insulin and is used to treat diabetes. The term does not include an insulin drug that is administered to a patient intravenously.

B.(1) A health coverage plan shall not impose a cost-sharing provision for insulin in the health coverage plan's formulary as prescribed in Subsection C of this Section if the total amount the enrollee is required to pay exceeds seventy-five dollars per prescription for a thirty-day supply, regardless of the amount or type of insulin needed to fill the enrollee's prescription.

(2)On January first of each year, the limit on the amount that an insured is required to pay for a thirty-day supply of a covered prescription of insulin as provided for in this Subsection shall increase by a percentage equal to the percentage change from the preceding year in the prescription drug component of the Consumer Price Index of the United States Department of Labor, Bureau of Labor Statistics.

C. A health coverage plan shall include at least one insulin from each therapeutic class in the plan's formulary that complies with the provisions of this Section.

Acts 2022, No. 724, §1.