                                 CODE OF VIRGINIA

LIMIT ON COST-SHARING PAYMENTS FOR PRESCRIPTION INSULIN DRUGS (§
38.2-3407.15:5)

A. As used in this section:
			&#8220;Carrier&#8221; has the same meaning ascribed thereto in subsection A
of &#xA7; 38.2-3407.15.
			&#8220;Cost-sharing payment&#8221; means the total amount a covered person is
required to pay at the point of sale in order to receive a prescription drug
that is covered under the covered person&#8217;s health plan.
			&#8220;Covered person&#8221; means a policyholder, subscriber, participant,
or other individual covered by a health plan.
			&#8220;Health plan&#8221; means any health benefit plan, as defined in &#xA7;
38.2-3438, that provides coverage for a prescription insulin drug.
			&#8220;Pharmacy benefits manager&#8221; means an entity that engages in the
administration or management of prescription drug benefits provided by a carrier
for the benefit of its covered persons.
			&#8220;Prescription insulin drug&#8221; means a prescription drug that
contains insulin and is used to treat diabetes.
			&#8220;Provider contract&#8221; has the same meaning ascribed thereto in
subsection A of &#xA7; 38.2-3407.15.

B. Every health plan offered by a carrier shall set the cost-sharing payment
that a covered person is required to pay for a covered prescription insulin drug
at an amount that does not exceed $50 per 30-day supply of the prescription
insulin drug, regardless of the amount or type of insulin needed to fill the
covered person&#8217;s prescription.

C. Nothing in this section shall prevent a carrier from setting a covered
person&#8217;s cost-sharing payment for a covered prescription insulin drug at
an amount that is less than the maximum amount permitted pursuant to subsection
B.

D. No provider contract between a carrier or its pharmacy benefits manager and a
pharmacy or its contracting agent shall contain a provision (i) authorizing the
carrier&#8217;s pharmacy benefits manager or the pharmacy to charge, (ii)
requiring the pharmacy to collect, or (iii) requiring a covered person to make a
cost-sharing payment for a covered prescription insulin drug in an amount that
exceeds the amount of the cost-sharing payment for the covered prescription
insulin drug established by the carrier pursuant to subsection B.

E. This section shall apply with respect to health plans and provider contracts
entered into, amended, extended, or renewed on or after January 1, 2021.

F. Pursuant to the authority granted by &#xA7; 38.2-223, the Commission may
adopt such rules and regulations as it may deem necessary to implement this
section.

HISTORY: 2020, c. 881.