AB555 - Establishes provisions relating to the coverage of prescription insulin drugs under certain policies of health insurance. (BDR 57-1167)

- 83rd Session (2025) EMERGENCY REQUEST of Speaker of the Assembly Assembly Bill No. 555–Assemblymember Yeager CHAPTER.......... AN ACT relating to insurance; establishing a maximum cost- sharing amount that certain health insurers may impose for a 30-day supply of prescription insulin drugs; and providing other matters properly relating thereto. Legislative Counsel’s Digest: Existing law requires certain policies of health insurance to include coverage for the management and treatment of diabetes. Existing law requires that such coverage be subject to the same deductible, copayment, coinsurance and other conditions as are required under the policy for other types of health care. (NRS 689A.0427, 689B.0357, 695B.1927, 695C.1727) Sections 1, 4, 6-9, 11, 15 and 16 of this bill prohibit certain private health insurers from imposing a deductible, copayment, coinsurance or other cost-sharing obligation greater than $35 for a 30- day supply of a prescription insulin drug. Sections 2, 5, 10 and 13 clarify that an insurer may be required by sections 1, 4, 9 or 11 to impose a different deductible, copayment or coinsurance for a 30-day supply of a prescription insulin drug than would otherwise be required by the relevant policy of health insurance for other types of health care. Section 3 of this bill authorizes the Commissioner of Insurance to require certain policies of insurance issued by a domestic insurer to a person who resides in another state to meet the requirements of section 1 in certain circumstances. Sections 12 and 17 of this bill indicate that the requirements of sections 11 and 16, respectively, are inapplicable to coverage provided by a health maintenance organization or managed care organization to: (1) recipients of Medicaid or insurance under the Children’s Health Insurance Program; and (2) government employees and their dependents. Section 14 of this bill authorizes the Commissioner to suspend or revoke the certificate of authority issued to a health maintenance organization that fails to comply with the requirements of section 11. The Commissioner would also be authorized to take such action against other insurers that fail to comply with the requirements of sections 1, 4, 6-9, 15 and 16. (NRS 680A.200) EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted. THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS: Section 1. Chapter 689A of NRS is hereby amended by adding thereto a new section to read as follows: 1. An insurer that offers or issues a policy of health insurance which provides coverage for prescription insulin drugs shall not impose against an insured a deductible, copayment, coinsurance or other cost-sharing obligation that is greater than $35 for a 30-day supply of a prescription insulin drug which is – 2 – - 83rd Session (2025) prescribed to the insured and covered by the insurer, regardless of the amount or type of prescription insulin drug prescribed. 2. As used in this section: (a) “Diabetes” includes type I, type II and gestational diabetes. (b) “Prescription insulin drug” means a prescription drug that contains insulin and is used to control blood glucose levels for the purpose of treating diabetes. Sec. 2. NRS 689A.0427 is hereby amended to read as follows: 689A.0427 1. No policy of health insurance that provides coverage for hospital, medical or surgical expenses may be delivered or issued for delivery in this state unless the policy includes coverage for the management and treatment of diabetes, including, without limitation, coverage for the self-management of diabetes. 2. An insurer who delivers or issues for delivery a policy specified in subsection 1: (a) Shall include in any disclosure of the coverage provided by the policy notice to each policyholder and subscriber under the policy of the availability of the benefits required by this section. (b) [Shall] Except as otherwise provided in section 1 of this act, shall provide the coverage required by this section subject to the same deductible, copayment, coinsurance and other such conditions for coverage that are required under the policy. 3. A policy of health insurance subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 1998, has the legal effect of including the coverage required by this section, and any provision of the policy that conflicts with this section is void. 4. As used in this section: (a) “Coverage for the management and treatment of diabetes” includes coverage for medication, equipment, supplies and appliances that are medically necessary for the treatment of diabetes. (b) “Coverage for the self-management of diabetes” includes: (1) The training and education provided to an insured person after the insured person is initially diagnosed with diabetes which is medically necessary for the care and management of diabetes, including, without limitation, counseling in nutrition and the proper use of equipment and supplies for the treatment of diabetes; (2) Training and education which is medically necessary as a result of a subsequent diagnosis that indicates a significant change in the symptoms or condition of the insured person and which – 3 – - 83rd Session (2025) requires modification of the insured person’s program of self- management of diabetes; and (3) Training and education which is medically necessary because of the development of new techniques and treatment for diabetes. (c) “Diabetes” includes type I, type II and gestational diabetes. Sec. 3. NRS 689A.330 is hereby amended to read as follows: 689A.330 If any policy is issued by a domestic insurer for delivery to a person residing in another state, and if the insurance commissioner or corresponding public officer of that other state has informed the Commissioner that the policy is not subject to approval or disapproval by that officer, the Commissioner may by ruling require that the policy meet the standards set forth in NRS 689A.030 to 689A.320, inclusive [.] , and section 1 of this act. Sec. 4. Chapter 689B of NRS is hereby amended by adding thereto a new section to read as follows: 1. An insurer that offers or issues a policy of group health insurance which provides coverage for prescription insulin drugs shall not impose against an insured a deductible, copayment, coinsurance or other cost-sharing obligation that is greater than $35 for a 30-day supply of a prescription insulin drug which is prescribed to the insured and covered by the insurer, regardless of the amount or type of prescription insulin drug prescribed. 2. As used in this section: (a) “Diabetes” includes type I, type II and gestational diabetes. (b) “Prescription insulin drug” means a prescription drug that contains insulin and is used to control blood glucose levels for the purpose of treating diabetes. Sec. 5. NRS 689B.0357 is hereby amended to read as follows: 689B.0357 1. No group policy of health insurance that provides coverage for hospital, medical or surgical expenses may be delivered or issued for delivery in this state unless the policy includes coverage for the management and treatment of diabetes, including, without limitation, coverage for the self-management of diabetes. 2. An insurer who delivers or issues for delivery a policy specified in subsection 1: (a) Shall include in any disclosure of the coverage provided by the policy notice to each policyholder and subscriber under the policy of the availability of the benefits required by this section. (b) [Shall] Except as provided in section 4 of this act, shall provide the coverage required by this section subject to the same – 4 – - 83rd Session (2025) deductible, copayment, coinsurance and other such conditions for coverage that are required under the policy. 3. A policy subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 1998, has the legal effect of including the coverage required by this section, and any provision of the policy that conflicts with this section is void. 4. As used in this section: (a) “Coverage for the management and treatment of diabetes” includes coverage for medication, equipment, supplies and appliances that are medically necessary for the treatment of diabetes. (b) “Coverage for the self-management of diabetes” includes: (1) The training and education provided to the employee or member of the insured group after the employee or member is initially diagnosed with diabetes which is medically necessary for the care and management of diabetes, including, without limitation, counseling in nutrition and the proper use of equipment and supplies for the treatment of diabetes; (2) Training and education which is medically necessary as a result of a subsequent diagnosis that indicates a significant change in the symptoms or condition of the employee or member of the insured group and which requires modification of his or her program of self-management of diabetes; and (3) Training and education which is medically necessary because of the development of new techniques and treatment for diabetes. (c) “Diabetes” includes type I, type II and gestational diabetes. Sec. 6. Chapter 689C of NRS is hereby amended by adding thereto a new section to read as follows: 1. A carrier that offers or issues a health benefit plan which provides coverage for prescription insulin drugs shall not impose against an insured a deductible, copayment, coinsurance or other cost-sharing obligation that is greater than $35 for a 30-day supply of a prescription insulin drug which is prescribed to the insured and covered by the carrier, regardless of the amount or type of prescription insulin drug prescribed. 2. As used in this section: (a) “Diabetes” includes type I, type II and gestational diabetes. (b) “Prescription insulin drug” means a prescription drug that contains insulin and is used to control blood glucose levels for the purpose of treating diabetes. – 5 – - 83rd Session (2025) Sec. 7. NRS 689C.425 is hereby amended to read as follows: 689C.425 A voluntary purchasing group and any contract issued to such a group pursuant to NRS 689C.360 to 689C.600, inclusive, are subject to the provisions of NRS 689C.015 to 689C.355, inclusive, and section 6 of this act, to the extent applicable and not in conflict with the express provisions of NRS 687B.408 and 689C.360 to 689C.600, inclusive. Sec. 8. Chapter 695A of NRS is hereby amended by adding thereto a new section to read as follows: 1. A society that offers or issues a benefit contract which provides coverage for prescription insulin drugs shall not impose against an insured a deductible, copayment, coinsurance or other cost-sharing obligation that is greater than $35 for a 30-day supply of a prescription insulin drug which is prescribed to the insured and covered by the society, regardless of the amount or type of prescription insulin drug prescribed. 2. As used in this section: (a) “Diabetes” includes type I, type II and gestational diabetes. (b) “Prescription insulin drug” means a prescription drug that contains insulin and is used to control blood glucose levels for the purpose of treating diabetes. Sec. 9. Chapter 695B of NRS is hereby amended by adding thereto a new section to read as follows: 1. A hospital or medical services corporation that offers or issues a policy of health insurance which provides coverage for prescription insulin drugs shall not impose against an insured a deductible, copayment, coinsurance or other cost-sharing obligation that is greater than $35 for a 30-day supply of a prescription insulin drug which is prescribed to the insured and covered by the hospital or medical services corporation, regardless of the amount or type of prescription insulin drug prescribed. 2. As used in this section: (a) “Diabetes” includes type I, type II and gestational diabetes. (b) “Prescription insulin drug” means a prescription drug that contains insulin and is used to control blood glucose levels for the purpose of treating diabetes. Sec. 10. NRS 695B.1927 is hereby amended to read as follows: 695B.1927 1. No contract for hospital or medical service that provides coverage for hospital, medical or surgical expenses may be delivered or issued for delivery in this state unless the contract includes coverage for the management and treatment of diabetes, – 6 – - 83rd Session (2025) including, without limitation, coverage for the self-management of diabetes. 2. An insurer who delivers or issues for delivery a contract specified in subsection 1: (a) Shall include in any disclosure of the coverage provided by the contract notice to each policyholder or subscriber covered under the contract of the availability of the benefits required by this section. (b) [Shall] Except as otherwise provided in section 9 of this act, shall provide the coverage required by this section subject to the same deductible, copayment, coinsurance and other such conditions for coverage that are required under the contract. 3. A contract for hospital or medical service subject to the provisions of this chapter that is delivered, issued for delivery or renewed on or after January 1, 1998, has the legal effect of including the coverage required by this section, and any provision of the contract that conflicts with this section is void. 4. As used in this section: (a) “Coverage for the management and treatment of diabetes” includes coverage for medication, equipment, supplies and appliances that are medically necessary for the treatment of diabetes. (b) “Coverage for the self-management of diabetes” includes: (1) The training and education provided to a person covered under the contract after the person is initially diagnosed with diabetes which is medically necessary for the care and management of diabetes, including, without limitation, counseling in nutrition and the proper use of equipment and supplies for the treatment of diabetes; (2) Training and education which is medically necessary as a result of a subsequent diagnosis that indicates a significant change in the symptoms or condition of the person covered under the contract and which requires modification of the person’s program of self-management of diabetes; and (3) Training and education which is medically necessary because of the development of new techniques and treatment for diabetes. (c) “Diabetes” includes type I, type II a [Text truncated for display. Full text available on LegiScan.]