Code of the District of Columbia

§ 48–855.02a. Insulin copayment or coinsurance limitation.

(a) A health insurer that provides coverage for prescription insulin drugs pursuant to the terms of a health benefits plan the insurer offers shall limit the total amount that an insured is required to pay for a 30-day supply of covered prescription insulin drugs at an amount not to exceed $30, regardless of the quantity or type of covered prescription insulin drug used to fill the insured's prescription.

(b) A health insurer that provides coverage for diabetes devices and diabetic ketoacidosis devices pursuant to the terms of a health benefits plan offered by the insurer, shall limit the total amount that an insured is required to pay for a 30-day supply of all medically necessary covered diabetes devices and diabetic ketoacidosis devices that are in accordance with the insured's diabetes treatment plan at an amount not to exceed $100.

(c) Pursuant to subsections (a) and (b) of this section, prescription insulin drugs, diabetes devices, and diabetic ketoacidosis devices shall be covered without being subject to a deductible and any cost sharing paid by an insured shall be applied toward the insured's deductible obligation.

(d) Nothing in this section prevents an insurer from reducing an insured's copayment or coinsurance by an amount greater than the amount specified in subsections (a) and (b) of this section.

(e) On July 1 of each year, the limit on a required copayment or coinsurance an insured is required to pay under subsections (a) and (b) of this section shall increase by a percentage equal to the percentage change from the preceding year in the medical care component of the Consumer Price Index for All Urban Consumers, Washington-Arlington-Alexandria, DC-VA-MD-WV metropolitan area, as published by the Bureau of Labor Statistics of the United States Department of Labor.

(f) This section shall apply as of January 1, 2022.