Kansas plans would cap what people pay for insulin and devices

Covered health plans would limit a person’s payment to $35 for covered insulin and $100 for covered devices. The limits would apply to people covered by the individual and group health plans and insurance arrangements listed in the bill. The device limit would cover items such as glucose monitors, test strips, and insulin syringes; insulin pumps are excluded. The coverage rule would apply to plans delivered, issued, amended, or renewed on or after January 1, 2027.

Covered plans would cover insulin in each listed category, diabetes education, and a written appeal process for people unable to take a listed insulin. These duties would apply to the individual and group health plans and insurance arrangements listed in the bill. Plans would cover at least one insulin drug in each category. A trained healthcare provider would give the education, and the written appeal must give the person and their provider a meaningful chance to take part. The coverage rule would apply to plans delivered, issued, amended, or renewed on or after January 1, 2027.

Health plans and pharmacy benefit managers could not require charges above the limits or reduce pharmacy payments because a person’s cost-sharing is affected. The rules would cover the listed health-plan providers, pharmacy benefit managers, and other parties that reimburse pharmacies for drugs or services. A contract between a health-plan provider and a pharmacy benefit manager could not allow charges above the limits. A party reimbursing a pharmacy could not lower payment or impose a fee based on the effect on a covered person’s cost-sharing. These rules would take effect when the act takes effect after publication in the statute book.