Cost sharing - prescription epinephrine - limits - rules - definition

(1) As used in this section, unless the context otherwise requires, epinephrine auto-injector has the same meaning as set forth in section 12-280-142 (1)(c).

(2) For health coverage plans issued or renewed on or after January 1, 2024, if a carrier provides coverage for prescription epinephrine auto-injectors, the carrier shall cap the total amount that a covered person is required to pay for all covered prescription epinephrine auto-injectors at an amount not to exceed sixty dollars for a two-pack of epinephrine auto-injectors, regardless of the amount or type of epinephrine needed to fill the covered person's prescription.

(3) Nothing in this section prevents a carrier from reducing a covered person's cost sharing to an amount that is lower than the amount specified in subsection (2) of this section.

(4) The coverage required by this section may be offered through a high deductible plan that includes a health savings account pursuant to 26 U.S.C. sec. 223 of the federal Internal Revenue Code of 1986; except that a carrier may apply deductible amounts for the required coverage if the coverage is not considered by the United States department of the treasury to be preventive or to have an acceptable deductible amount.

(5) The commissioner may use any of the commissioner's enforcement powers to obtain a carrier's compliance with this section.

(6) The commissioner may promulgate rules as necessary to implement and administer this section and to align with federal requirements.