62Q.481 COST-SHARING FOR PRESCRIPTION DRUGS AND RELATED MEDICAL SUPPLIES TO TREAT CHRONIC DISEASE.
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62Q.481 COST-SHARING FOR PRESCRIPTION DRUGS AND RELATED MEDICAL SUPPLIES TO TREAT CHRONIC DISEASE.
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Subdivision 1. Cost-sharing limits.
(a)A health plan must limit the amount of any enrollee cost-sharing for prescription drugs prescribed to treat a chronic disease to no more than:
(1)$25 per one-month supply for each prescription drug, regardless of the amount or type of medication required to fill the prescription; and
(2)$50 per month in total for all related medical supplies. The cost-sharing limit for related medical supplies does not increase with the number of chronic diseases for which an enrollee is treated. Coverage under this section shall not be subject to any deductible.
(b)If application of this section before an enrollee has met the enrollee's plan deductible results in:
(1)health savings account ineligibility under United States Code, title 26, section 223; or
(2)catastrophic health plan ineligibility under United States Code, title 42, section 18022(e), this section applies to the specific prescription drug or related medical supply only after the enrollee has met the enrollee's plan deductible.
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Subd. 2. Definitions.
(a)For purposes of this section, the following definitions apply.
(b)"Chronic disease" means diabetes, asthma, and allergies requiring the use of epinephrine auto-injectors.
(c)"Cost-sharing" means co-payments and coinsurance.
(d)"Related medical supplies" means syringes, insulin pens, insulin pumps, test strips, glucometers, continuous glucose monitors, epinephrine auto-injectors, asthma inhalers, and other medical supply items necessary to effectively and appropriately treat a chronic disease or administer a prescription drug prescribed to treat a chronic disease.