Enrolled Copy H.B. 24
1 PRESCRIPTION DISCOUNT PROGRAM AMENDMENTS
2 2023 GENERAL SESSION
3 STATE OF UTAH
4 Chief Sponsor: Raymond P. Ward
5 Senate Sponsor: Michael S. Kennedy
6
7 LONG TITLE
8 General Description:
9 This bill allows the Public Employees' Benefit and Insurance Program (program) to add
10 additional drugs to the prescription discount program.
11 Highlighted Provisions:
12 This bill:
13 < modifies definitions;
14 < allows the Public Employees' Benefit and Insurance Program to add additional
15 drugs to the prescription discount program;
16 < requires the program to notify the Legislature when an additional drug is added to
17 the program; and
18 < makes technical changes.
19 Money Appropriated in this Bill:
20 None
21 Other Special Clauses:
22 None
23 Utah Code Sections Affected:
24 AMENDS:
25 49-20-421, as last amended by Laws of Utah 2021, Chapter 255
26
27 Be it enacted by the Legislature of the state of Utah:
28 Section 1. Section 49-20-421 is amended to read:
29 49-20-421. Prescription discount program.
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30 (1) As used in this section:
31 [(a) "Diabetes" means:]
32 [(i) complete insulin deficiency or type 1 diabetes;]
33 [(ii) insulin resistant with partial insulin deficiency or type 2 diabetes; or]
34 [(iii) elevated blood glucose levels induced by pregnancy or gestational diabetes.]
35 [(b)] (a) "Discount program" means [a process developed by the program that allows
36 participants to purchase a qualified prescription at a discounted, post-rebate rate] the
37 prescription discount program created by this section.
38 [(c)] (b) "Epinephrine auto-injector" means the same as that term is defined in Section
39 26-41-102.
40 [(d) "Individual with diabetes" means an individual who has been diagnosed with
41 diabetes and who uses insulin to treat diabetes.]
42 [(e)] (c) "Insulin" means a prescription drug that contains insulin.
43 [(f)] (d) "Participant" means a resident of Utah who:
44 (i) [has a qualified condition] has a prescription or standing prescription for a qualified
45 prescription;
46 (ii) does not receive health coverage under the program; and
47 (iii) enrolls in the discount program.
48 [(g)] (e) "Prescription drug" means the same as that term is defined in Section
49 58-17b-102.
50 [(h) "Qualified condition" means the individual:]
51 [(i) uses insulin to treat diabetes; or]
52 [(ii) has a prescription or a standing prescription drug order for an epinephrine
53 auto-injector issued under Section 58-17b-1005.]
54 [(i) "Qualified prescription" means:]
55 [(i) insulin; or]
56 [(ii) epinephrine auto-injector.]
57 (f) "Qualified prescription" means a prescription drug, including insulin and
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58 epinephrine auto-injectors, that the program has determined:
59 (i) treats a serious, prevalent, and ongoing condition;
60 (ii) does not have a generic substitute;
61 (iii) qualifies for a substantial rebate; and
62 (iv) would not result in financial losses to the state risk pool if sold as part of the
63 discount program.
64 [(j)] (g) "Rebate" means the same as that term is defined in Section 31A-46-102.
65 (2) [Notwithstanding Subsection 49-20-201(1), and for the purpose of the discount
66 program only, the program shall offer a discount program that allows participants to purchase a
67 qualified prescription at a discounted, post-rebate price when a rebate is available.] The
68 program shall create a prescription discount program for a participant to purchase a qualified
69 prescription at a discounted, post-rebate price.
70 (3) The [discount] program [described in Subsection (2)] shall:
71 (a) provide a participant with a card or electronic document that identifies the
72 participant as eligible for the discount on a qualified prescription [related to the participant's
73 qualified condition];
74 (b) provide a participant with information about pharmacies that will honor the
75 discount; and
76 [(c) allow a participant to purchase a qualified prescription at a discounted, post-rebate
77 price; and]
78 [(d)] (c) provide a participant with instructions to pursue a reimbursement of the
79 purchase price from the participant's health insurer.
80 [(4) The discount program shall charge a price for a qualified prescription that allows
81 the program to retain only enough of any rebate for the qualified prescription to make the state
82 risk pool whole for providing a discounted qualified prescription to participants.]
83 (4) The program may not retain any amount of a rebate for a qualified prescription
84 except for an amount necessary to make the state risk pool whole for providing the qualified
85 prescription to participants.
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86 (5) For each drug added to the discount program, the program shall notify the Health
87 and Human Services Interim Committee, providing:
88 (a) the name of the drug; and
89 (b) the primary condition the drug treats.
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Statutes affected:
Introduced: 49-20-421
Enrolled: 49-20-421