WEST virginia legislature

2020 regular session

Originating

House Bill 4543

By Delegates Hill, Pack, Fleischauer, Bates, Jennings, Summers, Atkinson, C. Thompson, Angelucci, Rohrbach and Nelson

[Originating in the Committee on Health and Human Resources; January 22, 2020]

A BILL to repeal §33-15C-1 of the Code of West Virginia, 1931, as amended; to repeal §33-16-16, of said code; and to amend said code by adding thereto a new article designated, §33-53-1 of said code, all relating to insurance coverage for diabetics.

Be it enacted by the Legislature of West Virginia:

ARTICLE 15C. DIABETES INSURANCE.

§33-15C-1. Insurance for diabetics.

[Repealed]

ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.

§33-16-16. Insurance for diabetics.

[Repealed]

ARTICLE 53. Required coverage for Health INSURANCE.

§33-53-1. Cost sharing in prescription insulin drugs.

(a) Findings. –

(1) It is estimated that over 240,000 West Virginian’s are diagnosed and living with type 1 or type 2 diabetes and another 65,000 are undiagnosed;

(2) Every West Virginian with type 1 diabetes and many with type 2 diabetes rely on daily doses of insulin to survive;

(3) The annual medical cost related to diabetes in West Virginia is estimated at $2.5 billion annually;

(4) Persons diagnosed with diabetes will incur medical costs approximately 2.3 times higher than persons without diabetes;

(5) The cost of insulin has increased astronomically, especially the cost of insurance co-payments, which can exceed $600 per month. Similar increases in the cost of diabetic equipment and supplies, and insurance premiums has resulted in out-of-pocket costs for many West Virginian diabetics in excess of $1,000 per month;

(6) National reports indicate as many as one in four type 1 diabetics underuse, or ration, insulin due these increased costs. Rationing insulin has resulted in nerve damage, diabetic comas, amputation, kidney damage, and even death; and

(7) It is important to enact policies to reduce the costs for West Virginians with diabetes to obtain lifesaving and life-sustaining insulin.

(b) “Prescription insulin drug” means a drug containing insulin and is used to control blood glucose level to treat diabetes.

(c) Notwithstanding the provisions of §33-1-1 et seq. of this code, an insurer subject to §5-16-1 et seq., §33-15-1 et seq., §33-16-1 et seq., §33-24-1 et seq., §33-25-1 et seq., and §33-25A-1 of this code which issues or renews a health insurance policy on or after July 1, 2020, shall provide coverage for prescription insulin drugs pursuant to this section.

(d) Cost sharing for a 30 day supply of a prescription insulin drug shall not exceed $25 for a 30 day supply of a prescription insulin drug, regardless of the quantity or type of prescription insulin drug used to fill the covered person’s prescription needs.

(e) Nothing in this section prevents an insurer from reducing a covered person’s cost sharing by an amount greater than amount specified in this subsection.

(f) A drug manufacturer, drug wholesaler, or pharmacy benefit manager may not pass through the costs of the prescription insulin drug to the pharmacist or pharmacy. The commissioner may use any of the commissioner’s enforcement powers to obtain an insurer’s or pharmaceutical benefit manager’s compliance with this section. 

(g) An insurer subject to §5-16-1 et seq., §33-15-1 et seq., §33-16-1 et seq., §33-24-1 et seq., §33-25-1 et seq., and §33-25A-1 shall provide coverage for the following equipment and supplies for the treatment and/or management of diabetes for both insulin dependent and noninsulin dependent persons with diabetes and those with gestational diabetes: Blood glucose monitors, monitor supplies, insulin, injection aids, syringes, insulin infusion devices, pharmacological agents for controlling blood sugar and orthotics.

(g) An insurer subject to §5-16-1 et seq., §33-15-1 et seq., §33-16-1 et seq., §33-24-1 et seq., §33-25-1 et seq., and §33-25A-1 shall include coverage for diabetes self-management education to ensure that persons with diabetes are educated as to the proper self-management and treatment of their diabetes, including information on proper diets. Coverage for self-management education and education relating to diet shall be limited to:

(1) Visits medically necessary upon the diagnosis of diabetes;

(2) Visits under circumstances where a health care practitioner identifies or diagnoses a significant change in the patient's symptoms or conditions that necessitates changes in a patient's self-management; and

(3) Where a new medication or therapeutic process relating to the person's treatment and/or management of diabetes has been identified as medically necessary by a health care practitioner: Provided, That coverage for reeducation or refresher education shall be limited to $100 annually.

(h) The education may be provided by a health care practitioner as part of an office visit for diabetes diagnosis or treatment, or by a licensed pharmacist for instructing and monitoring a patient regarding the proper use of covered equipment, supplies and medications, or by a certified diabetes educator, or registered dietitian.

NOTE: The purpose of this bill is to cap costs for insulin and provide certain coverage mandates.

Strike-throughs indicate language that would be stricken from a heading or the present law and underscoring indicates new language that would be added.