Health plans would limit patients' payments for covered prescription insulin

Health plans covering prescription insulin would cap patients' share of the cost at $30 per drug for a 30-day supply. The cap would cover insulin used to treat diabetes, excluding insulin given through a vein. The cap would include deductibles, copayments, and coinsurance, which are the patient's share of covered care costs. The rule would apply to plans that cover prescription insulin; it would not require plans to offer that coverage. The rule would apply to health plans delivered, issued for delivery, continued, or renewed on or after January 1, 2027.

Insurers would calculate patients' insulin payments at the point of sale using a price reduced by at least the full rebate amount. The rule would cover prescription insulin used to treat diabetes, excluding insulin given through a vein. Rebates include discounts and other payments linked to providing the drug. The calculation would include amounts already received or expected. A fixed copayment could still be used, but it could not exceed the reduced drug price. Insurers could reduce patients' payments further. The rule would apply to health plans delivered, issued for delivery, continued, or renewed on or after January 1, 2027.

Insurers would keep specific rebate amounts confidential and require service providers with access to protect them. The protections would cover actual rebate amounts tied to a specific insulin product, manufacturer, or pharmacy. These amounts would be protected as trade secrets, meaning confidential business information. They would be excluded from public records and barred from direct or indirect disclosure. Insurers would have to extend these protections to outside providers handling health care or administrative services who could access the information. The rule would apply to health plans delivered, issued for delivery, continued, or renewed on or after January 1, 2027.