What is my cost share for insulin/
Carriers that provide coverage for prescription insulin drugs shall cap the cost-sharing charged to the covered person per prescription to $100 per thirty (30) day supply regardless of the type of insulin drug prescribed and filled in that thirty (30) day period. Carriers shall not charge any additional copayments, deductibles or coinsurance for an additional fill of that same prescription in that thirty (30) day period if that fill is to ensure the covered person has sufficient insulin available until the next thirty (30) day period begins.
B. Carriers may reduce prescription insulin drug cost-sharing to an amount less than $100 per thirty (30) day supply per prescription.
C. Carriers may charge up to $300 for a ninety (90) day supply of prescription insulin per prescription. Carriers shall not charge any additional copayments, deductibles or coinsurance for an additional fill of that same prescription in that ninety (90) day period if that fill is to ensure the covered person has sufficient insulin available until the next ninety (90) day period begins.
D. Pursuant to IRS Notice 2019-45, HSA-qualified high deductible health plans are permitted to provide benefits for insulin without a deductible; therefore, they shall comply with the requirements of this section and § 10-16-151, C.R.S.
Section 6 Severability
If any provision of this regulation or the application of it to any person or circumstances is for any reason held to be invalid, the remainder of this regulation shall not be affected.
Section 7 Incorporated Materials
Notice 2019-45 published by Internal Revenue Service shall mean Notice 2019-45 as published on the effective date of this regulation and does not include later amendments to or editions of Notice 2019-45. A copy of Notice 2019-45 may be examined during regular business hours at the Colorado Division of Insurance, 1560 Broadway, Suite 850, Denver, Colorado, 80202, or by visiting the Internal Revenue Service website at https://www.irs.gov/pub/irs-drop/n-19-45.pdf. Certified copies of Notice 2019-45, published by the Internal Revenue Service are available from the Colorado Division of Insurance for a fee.
Section 9 Enforcement
Noncompliance with this regulation may result in the imposition of any of the sanctions made available in the Colorado statutes pertaining to the business of insurance, or other laws, which include the imposition of civil penalties, issuance of cease and desist orders, and/or suspensions or revocation of license, subject to the requirements of due process.
Section 9 Effective Date
This regulation shall become effective April 1, 2020.