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§ 15-822.1. Coverage for prescription insulin drugs under health insurance

West's Annotated Code of MarylandInsuranceEffective: January 1, 2023

West's Annotated Code of Maryland
Insurance (Refs & Annos)
Title 15. Health Insurance
Subtitle 8. Required Health Insurance Benefits (Refs & Annos)
Effective: January 1, 2023
MD Code, Insurance, § 15-822.1
§ 15-822.1. Coverage for prescription insulin drugs under health insurance
Currentness
Application of section
(a)(1) This section applies to:
(i) insurers and nonprofit health service plans that provide coverage for prescription drugs and devices to individuals or groups under health insurance policies or contracts that are delivered in the State; and
(ii) health maintenance organizations that provide coverage for prescription drugs and devices to individuals or groups under contracts that are issued or delivered in the State.
(2) An insurer, a nonprofit health service plan, or a health maintenance organization that provides coverage for prescription drugs and devices through a pharmacy benefits manager is subject to the requirements of this section.
Limit of amount individual required to pay for insulin
(b) An entity subject to this section shall limit the amount a covered individual is required to pay in copayments or coinsurance for a covered prescription insulin drug to not more than $30 for a 30-day supply, regardless of the amount or type of insulin needed to fill the covered individual's prescription.
Amount may be less than limit
(c) An entity subject to this section may set the amount a covered individual is required to pay to an amount that is less than the payment amount limit under subsection (b) of this section.
Limits on contract between entity and pharmacy
(d) A contract between an entity subject to this section, or a pharmacy benefits manager through which the entity provides coverage for prescription drugs and devices, and a pharmacy or the pharmacy's contracting agent, may not:
(1) authorize a party to the contract to charge a covered individual an amount that is more than the payment amount limit under subsection (b) of this section;
(2) require a pharmacy to collect from a covered individual an amount that is more than the payment amount limit under subsection (b) of this section; or
(3) require a covered individual to pay an amount that is more than the payment amount limit under subsection (b) of this section.

Credits

Added by Acts 2022, c. 405, § 1, eff. Jan. 1, 2023.
MD Code, Insurance, § 15-822.1, MD INSURANCE § 15-822.1
Current through legislation effective through April 9, 2023, from the 2024 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
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