Amendment ID: S2397-19

Amendment 19

Implementation and Study for Insulin Cost Sharing

Ms. DiZoglio moves that the proposed new draft be amended by striking section 39 in its entirety and replacing it with the following:-

"SECTION 39. Notwithstanding any general or special law to the contrary, there shall be a 4-year program to assess the public health utilization and cost impacts of capping co-pays and eliminating deductible and co-insurance requirements for insulin for individuals with diabetes. To implement the program any policy, contract or certificate of health insurance subject to chapters 32A, 118E, 175, 176A, 176B, 176G or 176Q of the General Laws that is delivered, issued or renewed from January 1, 2021 to December 31, 2024, inclusive, shall provide coverage for insulin for the treatment of diabetes. Such coverage shall not be subject to any deductible or co-insurance and any co-pay shall not exceed $25 per month per insulin prescription.

The center for health information and analysis shall collect, analyze and evaluate data at the start of the program and annually thereafter, including, but not limited to: (i) rates of insulin utilization; (ii) average monthly out-of-pocket insulin costs; (iii) annual plan costs and member premiums; (iv) the average price of insulin, net of rebates or discounts received by or accrued directly or indirectly by health insurance carriers; and (v) average and total out-of-pocket expenditures on insulin delivery devices that are not included as part of an insulin prescription. The center shall file an interim 2-year report and a final 4-year report assessing the program’s impact on insulin utilization, member premiums and insulin prices, providing data on expenditures on insulin delivery devices separate from insulin prescriptions, and the impact on the state’s cost growth benchmark. If the center, in the interim 2-year report, finds significant increases in the list price of insulin that impact health care spending in the commonwealth, the health policy commission, in consultation with the center shall file a report to the clerks of the house of representatives and senate, and the joint committee on public health, the joint committee on health care financing and the house and senate committees on ways and means not later than March 1, 2023 that summarizes the center’s preliminary findings and makes recommendations to modify the requirements of this section to reduce the impact of the price increases on health care spending in the commonwealth.  The final 4-year report shall be filed with the clerks of the house of representatives and senate, the joint committee on public health, the joint committee on health care financing and the house and senate committees on ways and means not later than March 1, 2025."