SPONSOR:

Rep. Bentz & Rep. Bennett & Rep. Minor-Brown

HOUSE OF REPRESENTATIVES

150th GENERAL ASSEMBLY

HOUSE AMENDMENT NO. 1

TO

HOUSE BILL NO. 263

AMEND House Bill No. 263 o n lines 10, 27, and 43 by inserting the following after “ prescriptions. ”:

The $100 per month cap includes deductible payments and cost-sharing amounts charged once a deductible is met. ”.

FURTHER AMEND House Bill No. 263 o n 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 ”.

FURTHER AMEND House Bill No. 263 o n lines 12 and 29 by deleting “ carrier. ” after “ the ” and inserting in lieu thereof the following:

carrier:

a. Rapid-acting.

b. Short-acting.

b. Intermediate-acting.

c. Long-acting.

(3) For purposes of paragraph (b)(2) of this section, the “lowest tier of the drug formulary” means either of the following:

a. If the prescription insulin drug is a generic drug, the lowest tier for generic drugs.

b. If the prescription insulin drug is a brand-name drug, the lowest tier for brand-name drugs. ”.

FURTHER AMEND House Bill No. 263 o n lines 13 and 30 by deleting “ Nothing ” between “ (c) ” and “ in ” and inserting in lieu thereof the 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 o n line 23 by deleting “ An individual ” between “ (b) ” and “ health ” and inserting in lieu thereof “ A group or blanket ”.

FURTHER AMEND House Bill No. 263 o n line 45 by deleting “ carrier. ” after “ the ” and inserting in lieu thereof the following:

carrier:

a. Rapid-acting.

b. Short-acting.

b. Intermediate-acting.

c. Long-acting.

(3) For purposes of paragraph (b)(2) of this section, the “lowest tier of the drug formulary” means either of the following:

a. If the prescription insulin drug is a generic drug, the lowest tier for generic drugs.

b. If the prescription insulin drug is a brand-name drug, the lowest tier for brand-name drugs.

(c) The cap on the amount a covered individual is required to pay under paragraph (b)(1) of this section applies to an enrolled individual who is in compliance with all coordination of benefits policies of the plan, including spousal coordination of benefits. ”.

SYNOPSIS

This Amendment revises House Bill No. 263 by doing all of the following:

1. Requires at least 1 formulation of each type of prescription insulin be on the lowest tier of the drug formulary.

2. Defines the "lowest tier of the drug formulary" as the lowest tier for generic drugs, if the insulin is a generic and the lowest tier for brand-name drugs, if the insulin is brand-name.

3. Clarifies that the $100 per month cost-sharing cap includes deductible payments and cost-sharing amounts charged once a deductible is met.

4. Corrects the date for the applicability of this Act so it includes insurance plans that begin on January 1, 2021.

5. Clarifies that the cap on the copay applies to covered individuals who are in compliance with the coordination of benefits policies under the State employee insurance plans.

6. Corrects a typographical error.