AB 411

This bill prohibits every health insurance policy and governmental

self-insured health plan that covers insulin and that imposes cost sharing on

prescription drugs from imposing cost sharing on insulin in an amount that exceeds

the lesser of the following: $100 for a one-month supply of insulin or the greater of

the amount that is 125 percent of the cost of insulin or the amount generated by

subtracting 51 percent of the total rebates received by the policy or plan from the

cost-sharing amount that would be charged to a covered person for insulin if it is

treated as any other prescription drug under the policy or plan. The bill also requires

the commissioner of insurance to investigate and report on the pricing of insulin.

Health insurance policies are known in the bill as disability insurance policies.

Current law requires every health insurance policy that provides coverage of

expenses incurred for treatment of diabetes to provide coverage for expenses

incurred by the installation and use of an insulin infusion pump; coverage for all

other equipment and supplies, including insulin or any other prescription

medication, used in the treatment of diabetes; and coverage of diabetic

self-management education programs. Except for allowing an exception for insulin

infusion pump coverage, the required coverage under current law for certain

diabetes treatments is subject to the same exclusions, limitations, deductibles, and

coinsurance provisions of the policy as other covered expenses. The bill's

cost-sharing limitations on insulin supersede the specification that the exclusions,

limitations, deductibles, and coinsurance are the same as for other coverage.

This proposal may contain a health insurance mandate requiring a social and

financial impact report under s. 601.423, stats.