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HF 405

A bill for an act relating to insurance coverage for prescription insulin drugs.

2025-2026 Regular Session Introduced by Josh Turek

Bill HF 405 caps out-of-pocket costs for insulin, ensuring individuals with diabetes can access necessary medications without financial strain, effective January 2026.

Withdrawn. H.J. 12/19.
#insulin #insurance #prescriptiondrugs
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Bill Summary · HF 405

Summary of Bill HF 405: Insurance Coverage for Prescription Insulin Drugs

Purpose and Intent

Bill HF 405 aims to address the rising costs of prescription insulin drugs by mandating insurance coverage policies to limit the out-of-pocket expenses for individuals who require insulin. The bill seeks to ensure that individuals with diabetes can access necessary medications without facing excessive financial burdens.

Key Provisions

  • Cost-Sharing Cap: The bill requires that any third-party payment provider (such as insurance companies) that covers prescription drugs must cap the total amount of cost-sharing for insulin drugs. This means that individuals will not pay more than a specified amount for their insulin prescriptions.

  • Applicable Policies: The provisions of this bill apply to various types of insurance contracts, including:

    • Individual or group accident and sickness insurance.
    • Individual or group hospital or medical service contracts.
    • Health maintenance organization (HMO) contracts.
    • Plans established for public employees.

  • Exclusions: The bill does not apply to certain types of insurance, including:

    • Accident-only or specified disease insurance.
    • Short-term hospital or medical insurance.
    • Dental and vision insurance.
    • Medicare supplement and long-term care insurance.
    • Workers’ compensation and automobile medical payment insurance.

  • Implementation Date: The provisions of the bill will take effect for policies delivered, issued for delivery, continued, or renewed on or after January 1, 2026.

  • Regulatory Authority: The commissioner of insurance is authorized to adopt rules to administer the provisions of this bill.

Who Would Be Affected

  • Individuals with Diabetes: The primary beneficiaries of this bill are individuals who require insulin for diabetes management, as it aims to reduce their financial burden related to insulin costs.

  • Insurance Providers: Insurance companies and health plans will need to adjust their policies to comply with the new cost-sharing requirements.

  • Healthcare System: The bill may impact the overall healthcare system by potentially increasing access to insulin for patients, which could lead to better health outcomes and reduced emergency care costs associated with unmanaged diabetes.

Legislative Timeline

  • Introduced: February 13, 2025
  • Current Status: The bill has been introduced and referred to the Commerce Committee for further consideration.

Conclusion

HF 405 represents a significant step towards making insulin more affordable for those who depend on it for their health. By capping out-of-pocket costs, the bill aims to alleviate financial stress for patients and ensure better access to essential medications. As it progresses through the legislative process, stakeholders will be watching its development closely.

Compiled from official sources — confirm details with the bill’s official record.

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