§ 49-20-421 — Prescription discount program.

Utah § 49-20-421

• Jurisdiction: Utah
• Title 49: Utah State Retirement and Insurance Benefit Act
• Ch. 49-20: Public Employees' Benefit and Insurance Program Act
• Part 49-20-4: Insurance Program

Text

(1) As used in this section:
(1)(a) "Discount program" means the prescription discount program created by this section.
(1)(b) "Epinephrine auto-injector" means a portable, disposable drug delivery device that contains a measured, single dose of epinephrine that is used to treat a person suffering a potentially fatal anaphylactic reaction.
(1)(c) "Insulin" means a prescription drug that contains insulin.
(1)(d) "Participant" means a resident of Utah who:
(1)(d)(i) has a prescription or standing prescription for a qualified prescription;
(1)(d)(ii) does not receive health coverage under the program; and
(1)(d)(iii) enrolls in the discount program.
(1)(e) "Prescription drug" means the same as that term is defined in Section 58-17b-102.
(1)(f) "Qualified prescription" means a prescription drug, including insulin and epinephrine auto-injectors, that the program has determined:
(1)(f)(i) treats a serious, prevalent, and ongoing condition;
(1)(f)(ii) does not have a generic substitute;
(1)(f)(iii) qualifies for a substantial rebate; and
(1)(f)(iv) would not result in financial losses to the state risk pool if sold as part of the discount program.
(1)(g) "Rebate" means the same as that term is defined in Section 31A-46-102.
(2) The program shall create a prescription discount program for a participant to purchase a qualified prescription at a discounted, post-rebate price.
(3) The program shall:
(3)(a) provide a participant with a card or electronic document that identifies the participant as eligible for the discount on a qualified prescription;
(3)(b) provide a participant with information about pharmacies that will honor the discount; and
(3)(c) provide a participant with instructions to pursue a reimbursement of the purchase price from the participant's health insurer.
(4) The program may not retain any amount of a rebate for a qualified prescription except for an amount necessary to make the state risk pool whole for providing the qualified prescription to participants.
(5) For each drug added to the discount program, the program shall notify the Health and Human Services Interim Committee, providing:
(5)(a) the name of the drug; and
(5)(b) the primary condition the drug treats.

Legislative History

Amended by Chapter 122, 2025 General Session