Section 54-52.1-04.18 - [Exp. 8/1/2025] Health insurance benefits coverage - Insulin drug and supply out-of-pocket limitations1. As used in this section: a. "Insulin drug" means a prescription drug that contains insulin and is used to treat a form of diabetes mellitus. The term does not include an insulin pump, an electronic insulin-administering smart pen, or a continuous glucose monitor, or supplies needed specifically for the use of such electronic devices. The term includes insulin in the following categories: (1) Rapid-acting insulin; (2) Short-acting insulin; (3) Intermediate-acting insulin; (5) Premixed insulin product; (6) Premixed insulin/GLP-1 RA product; and (7) Concentrated human regular insulin. b. "Medical supplies for insulin dosing and administration" means supplies needed for proper insulin dosing, as well as supplies needed to detect or address medical emergencies in an individual using insulin to manage diabetes mellitus. The term does not include an insulin pump, an electronic insulin-administering smart pen, or a continuous glucose monitor, or supplies needed specifically for the use of such electronic devices. The term includes: (1) Blood glucose meters; (2) Blood glucose test strips; (3) Lancing devices and lancets; (4) Ketone testing supplies, such as urine strips, blood ketone meters, and blood ketone strips; (5) Glucagon, in injectable and nasal forms; (6) Insulin pen needles; and c. "Pharmacy or distributor" means a pharmacy or medical supply company, or other medication or medical supply distributor filling a covered individual's prescriptions. 2. The board shall provide health insurance benefits coverage that provides for insulin drug and medical supplies for insulin dosing and administration which complies with this section. 3. The coverage must limit out-of-pocket costs for a thirty-day supply of : a. Covered insulin drugs which may not exceed twenty-five dollars per pharmacy or distributor, regardless of the quantity or type of insulin drug used to fill the covered individual's prescription needs. b. Covered medical supplies for insulin dosing and administration, the total of which may not exceed twenty-five dollars per pharmacy or distributor, regardless of the quantity or manufacturer of supplies used to fill the covered individual's prescription needs. 4. The coverage may not allow a pharmacy benefits manager or the pharmacy or distributor to charge, require the pharmacy or distributor to collect, or require a covered individual to make a payment for a covered insulin drug or medical supplies for insulin dosing and administration in an amount that exceeds the out-of-pocket limits set forth under subsection 3. 5. The coverage may not impose a deductible, copayment, coinsurance, or other cost-sharing requirement that causes out-of-pocket costs for prescribed insulin or medical supplies for insulin dosing and administration to exceed the amount set forth under subsection 3. 6. Subsection 3 does not require the coverage to implement a particular cost-sharing structure and does not prevent the limitation of out-of-pocket costs to less than the amount specified under subsection 3. Subsection 3 does not limit out-of-pocket costs on an insulin pump, an electronic insulin-administering smart pen, or a continuous glucose monitor. This section does not limit whether coverage classifies an insulin pump, an electronic insulin-administering smart pen, or a continuous glucose monitor as a drug or as a medical device or supply.7. If application of subsection 3 would result in the ineligibility of a health benefit plan that is a qualified high-deductible health plan to qualify as a health savings account under section 223 of the Internal Revenue Code [26 U.S.C. 223], the requirements of subsection 3 do not apply with respect to the deductible of the health benefit plan until after the enrollee has satisfied the minimum deductible under section 26 U.S.C. 223.8. This section does not apply to the Medicare part D prescription drug coverage plan. Amended by S.L. 2023, ch. 44 (SB 2012),§ 38, eff. 7/1/2023.Added by S.L. 2023 , ch. 516( SB 2140 ), § 4, eff. 8/1/2023, app. to public employees retirement system health benefits coverage that begins 7/1/2023, and which does not extend past 6/30/2025, exp. 8/1/2025.