wa-law.org > bill > 2023-24 > HB 1725 > Substitute Bill
By January 1, 2025, the health care authority shall establish a copayment offset program for insulin for individuals under the age of 21. The health care authority shall develop a process to eliminate out-of-pocket costs for insulin for enrollees under the age of 21 of health plans offered by health carriers regulated under chapter 48.43 RCW and health plans offered to public employees under chapter 41.05 RCW. An enrollee of a health plan may not be responsible for any cost sharing for insulin.
Health carriers shall participate in the program and enrollees may not be responsible for any cost sharing. The health care authority shall reimburse a carrier for an enrollee's cost-sharing obligation.
In order to receive reimbursement, a carrier must provide the health care authority with an end-of-calendar-year reconciliation for any cost-sharing reductions owed to the carrier pursuant to this section.
The health care authority is authorized to:
Bill, charge, and receive payment from health carriers; and
Perform any other functions as may be necessary or proper to establish and administer the program.
For health plans issued or renewed on or after January 1, 2024, health carriers shall participate in the copayment offset program for insulin for individuals under the age of 21 established in section 1 of this act once the program is operational.
If the federal internal revenue service removes insulin from the list of preventive care services which can be covered by a qualifying health plan for a health savings account before the deductible is satisfied, for a health plan that provides coverage for prescription insulin drugs for the treatment of diabetes and is offered as a qualifying health plan for a health savings account, the carrier shall establish the plan's cost sharing for the coverage of prescription insulin for diabetes at the minimum level necessary to preserve the enrollee's ability to claim tax exempt contributions from his or her health savings account under internal revenue service laws and regulations. The office of the insurance commissioner shall provide written notice of the change in internal revenue service guidance to affected parties, the chief clerk of the house of representatives, the secretary of the senate, the office of the code reviser, and others as deemed appropriate by the office of the insurance commissioner.
For health plans offered to employees and their covered dependents under this chapter issued or renewed on or after January 1, 2024, health carriers shall participate in the copayment offset program for insulin for individuals under the age of 21 established in section 1 of this act once the program is operational.
If the federal internal revenue service removes insulin from the list of preventive care services which can be covered by a qualifying health plan for a health savings account before the deductible is satisfied, for a health plan that provides coverage for prescription insulin drugs for the treatment of diabetes and is offered as a qualifying health plan for a health savings account, the carrier shall establish the plan's cost sharing for the coverage of prescription insulin for diabetes at the minimum level necessary to preserve the enrollee's ability to claim tax exempt contributions from his or her health savings account under internal revenue service laws and regulations. The office of the insurance commissioner shall provide written notice of the change in internal revenue service guidance to affected parties, the chief clerk of the house of representatives, the secretary of the senate, the office of the code reviser, and others as deemed appropriate by the office of the insurance commissioner.
The health care authority and the office of the insurance commissioner may adopt rules necessary to implement this act.