(a)For purposes of this section, “prescription insulin drug” means a drug containing insulin that is dispensed under Chapter 47 of Title 16 for the treatment of diabetes.
(b)The plan must provide coverage for prescription insulin drugs that does all of the following:
(1)Caps the total amount that a covered individual is required to pay for covered prescription insulin drugs at no more than $100 per month for each enrolled individual, regardless of the amount or types of insulin needed to fill the covered individual’s prescriptions. The $100 per month cap includes deductible payments and cost-sharing amounts charged once a deductible is met.
(2)Includes at least 1 formulation of each of the following types of prescription insulin drugs on the lowest tier of the drug formulary develop
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(a) For purposes of this section, “prescription insulin drug” means a drug containing insulin that is dispensed under Chapter 47 of Title 16 for the treatment of diabetes.
(b) The plan must provide coverage for prescription insulin drugs that does all of the following:
(1) Caps the total amount that a covered individual is required to pay for covered prescription insulin drugs at no more than $100 per month for each enrolled individual, regardless of the amount or types of insulin needed to fill the covered individual’s prescriptions. The $100 per month cap includes deductible payments and cost-sharing amounts charged once a deductible is met.
(2) Includes at least 1 formulation of each of the following types of prescription insulin drugs on the lowest tier of the drug formulary developed and maintained by the carrier:
a. Rapid-acting.
b. Short-acting.
c. Intermediate-acting.
d. Long-acting.
(3) For purposes of paragraph (b)(2) of this section, the “lowest tier of the drug formulary” means either of the following:
a. If the prescription insulin drug is a generic drug, the lowest tier for generic drugs.
b. If the prescription insulin drug is a brand-name drug, the lowest tier for brand-name drugs.
(c) The cap on the amount a covered individual is required to pay under paragraph (b)(1) of this section applies to an enrolled individual who is in compliance with all coordination of benefits policies of the plan, including spousal coordination of benefits.