An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in casualty insurance, providing for coverage for insulin.
Summary
HB305 would amend Pennsylvania’s Insurance Company Law of 1921 to cap out-of-pocket costs for insulin under health insurance policies that include prescription drug coverage. Specifically, it prohibits a covered individual’s copayment, coinsurance, or deductible for insulin from exceeding $35 for a 30-day supply, regardless of the amount or type of insulin needed. Insurers would still be allowed to charge less than that amount, and the Insurance Department would be authorized to write regulations to carry out and enforce the cap.
The bill also directs the Attorney General to investigate insulin pricing practices and the role of manufacturers in current insulin costs. The investigation must be reported to the General Assembly and made public within one year of the effective date, and the report must include a summary of pricing practices, policy recommendations to prevent overpricing, and any other information the Attorney General deems necessary. The act would take effect 60 days after enactment.
Impact
HB305 would add a new section to the state insurance code governing casualty/health insurance prescription coverage and would create a statewide insulin cost-sharing limit for most health plans. It would not apply to several categories of coverage, including accident-only, fixed indemnity, limited benefit, dental, vision, Medicare supplement, CHAMPUS supplement, long-term care, disability income, workers’ compensation, and automobile medical payment policies. The bill also expands state oversight by giving the Attorney General a formal investigative role and requiring a public report on insulin pricing and consumer protections.
Sentiment
The available voting history suggests strong support in committee: the House Health Committee voted 26-0 to re-refer the bill, indicating unanimous approval among those voting. No committee transcript is available, but the vote pattern suggests the bill was viewed favorably as a consumer-protection measure aimed at lowering insulin costs. The absence of recorded opposition in the vote history points to broad agreement on the need to address insulin affordability.
Contention
The main policy issues likely concern how far the state should go in regulating insulin pricing and which insurance products should be exempt from the cap. The bill’s $35 limit could draw scrutiny from insurers and possibly manufacturers over cost-shifting, administrative burden, or effects on premiums, while consumer advocates are likely to support the cap as necessary relief for people with diabetes. The Attorney General’s mandated investigation into manufacturer pricing practices also suggests concern about pharmaceutical pricing behavior and whether additional protections may be needed.
In casualty insurance, further providing for conditions subject to which policies are to be issued and for health insurance coverage for certain children of insured parents.
In casualty insurance, further providing for conditions subject to which policies are to be issued and for group accident and sickness insurance; and, in community health reinvestment, further providing for definitions.