HB 263 — AN ACT TO AMEND TITLE 18 AND TITLE 29 OF THE DELAWARE CODE RELATING TO COST SHARING IN PRESCRIPTION INSULIN DRUGS.

Minor-BrownDorsey HOUSEWalker OF& REPRESENTATIVESRep. 150th GENERAL ASSEMBLY HOUSE AMENDMENT NO.

1Minor-Brown TO& HOUSESen. BILL NO.

263Townsend AMEND& HouseSen. Bill No.

263Brown onReps. lines 10, 27, and 43 by inserting the following after “prescriptions.”:

“TheBaumbach, $100Bolden, perBrady, monthChukwuocha, capCooke, includesGriffith, deductibleHeffernan, paymentsJaques, andK. cost-sharing amounts charged once a deductible is met.”.

FURTHERJohnson, AMENDKowalko, HouseLonghurst, BillLynn, No.Mitchell, Osienski, Seigfried, Michael Smith, Viola, K.

263Williams; on lines 11, 28, and 44, by deleting “insulin” between “of” and “on” and inserting in lieu thereof “each of the following types of prescription insulin drugs”.

FURTHERSens. AMEND House Bill No.

263Lockman, onLopez, linesMcDowell, 12Paradee, andSokola, 29Sturgeon, byWalsh deletingHOUSE “carrier.”OF afterREPRESENTATIVES “the”150th andGENERAL insertingASSEMBLY inHOUSE lieuBILL thereofNO. the following:

“carrier:263 AN ACT TO AMEND TITLE 18 AND TITLE 29 OF THE DELAWARE CODE RELATING TO COST SHARING IN PRESCRIPTION INSULIN DRUGS.

a.BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF DELAWARE:

Rapid-acting.Section 1.

b.Amend Chapter 33, Title 18 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:

Short-acting.§ 3344B.

b.Cost sharing in prescription insulin drugs.

Intermediate-acting.(a) For purposes of this section, “prescription insulin drug” means a drug containing insulin that is dispensed under Chapter 47 of Title 16 for the treatment of diabetes.

c.(b) An individual health insurance policy, contract, or certificate that is delivered, issued for delivery, renewed, extended, or modified in this State that provides coverage for prescription insulin drugs must do all of the following:

Long-acting.(1) Cap the total amount that a covered individual is required to pay for covered prescription insulin drugs at no more than $100 per month for each enrolled individual, regardless of the amount or types of insulin needed to fill the covered individual’s prescriptions.

(3)(2) ForInclude purposesat ofleast paragraph1 (b)(2)formulation of thisinsulin section,on the “lowestlowest tier of the drug formulary”formulary meansdeveloped eitherand ofmaintained by the following:carrier.

a.(c) Nothing in this section prevents the operation of a policy provision required by this section as a deductible, coinsurance, allowable charge limitation, coordination of benefits, or a provision restricting coverage to services by a licensed, certified, or carrier-approved provider or facility.

If(d) theThis prescriptionsection insulinapplies drugto isall apolicies, genericcontracts, drug,or thecertificates lowestissued, tierrenewed, formodified, genericaltered, drugs.amended, or reissued after January 1, 2021.

b.Section 2.

IfAmend Chapter 35, Title 18 of the prescriptionDelaware insulinCode drugby ismaking adeletions brand-nameas drug,shown theby loweststrike tierthrough forand brand-nameinsertions drugs.”.as shown by underline as follows:

FURTHER§ AMEND3560A. House Bill No.

263Cost onsharing lines 13 and 30 by deleting “Nothing” between “(c)” and “in” and inserting in lieuprescription thereofinsulin thedrugs. following:

“Except as provided under paragraph (b)(1) of this section, nothing”.

FURTHER AMEND House Bill No.

263 on line 17 and 34 by deleting “January 1, 2021.” after “after” and inserting in lieu thereof “December 31, 2020.”.

FURTHER AMEND House Bill No.

263 on line 23 by deleting “An individual” between “(b)” and “health” and inserting in lieu thereof “A group or blanket”.

01/29/202001/09/2020 08:5808:13 AM FURTHER(a) AMENDFor Housepurposes Billof No.this section, “prescription insulin drug” means a drug containing insulin that is dispensed under Chapter 47 of Title 16 for the treatment of diabetes.

263(b) onAn lineindividual 45health byinsurance deletingpolicy, “carrier.”contract, afteror “the”certificate andthat insertingis delivered, issued for delivery, renewed, extended, or modified in lieuthis thereofState that provides coverage for prescription insulin drugs must do all of the following:

“carrier:(1) Cap the total amount that a covered individual is required to pay for covered prescription insulin drugs at no more than $100 per month for each enrolled individual, regardless of the amount or types of insulin needed to fill the covered individual’s prescriptions.

a.(2) Include at least 1 formulation of insulin on the lowest tier of the drug formulary developed and maintained by the carrier.

Rapid-acting.(c) Nothing in this section prevents the operation of a policy provision required by this section as a deductible, coinsurance, allowable charge limitation, coordination of benefits, or a provision restricting coverage to services by a licensed, certified, or carrier-approved provider or facility.

b.(d) This section applies to all policies, contracts, or certificates issued, renewed, modified, altered, amended, or reissued after January 1, 2021.

Short-acting.Section 3.

b.Amend Chapter 52, Title 29 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:

Intermediate-acting.§ 5212.

c.Cost sharing in prescription insulin drugs.