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Commission hears step‑2 assessments on prescription drug cost‑sharing and insulin/supplies caps; votes deferred after loss of quorum
Summary
The Bureau of Insurance presented step‑2 assessments on a prescription‑drug cost‑sharing limit and a proposal to cap insulin and diabetes supplies at $35; the commission deferred action after losing quorum.
The commission received two step‑2 assessments: one on a proposal to limit prescription‑drug cost sharing across plan tiers and another on House Bill 760 (as presented), which would cap insulin and diabetes equipment/supplies cost sharing at $35.
Mark Shipman of the Bureau of Insurance presented the step‑2 review on HB 946 (a proposal requiring at least 50% of plans in each rating area to cap prescription‑drug out‑of‑pocket costs at a fixed dollar amount). Shipman summarized carrier survey results about formulary tiers and reported an estimated premium impact of about $23.76 per member per month (PMPM) across the affected markets, with a total shift of approximately $183 million attributable to the proposed cost‑sharing limits. Because cost‑sharing limits would change how costs are borne between members and carriers, BOI said carriers could respond by changing benefit design or premiums elsewhere in their plans.
Rebecca Allen presented the step‑2 assessment for HB 760, which would lower the statutory cap on a 30‑day insulin supply from $50 to $35 and would create a $35 cap for diabetes equipment and supplies (blood‑glucose test strips, syringes, pump supplies and similar items), aggregated across items. BOI said current insulin copays range from $0 to $50 and that diabetes equipment cost sharing varies widely; using available claims and carrier data BOI estimated an overall premium impact of about $0.18 PMPM (eighteen cents) and a total market cost shift of roughly $3.1 million.
Kelly Fitzgerald, representing the American Cancer Society Cancer Action Network and Leukemia & Lymphoma Society (part of a patient coalition called Fair Health Virginia), offered public comment in support of the prescription‑drug cost‑sharing proposal and asked BOI for further conversations about underlying assumptions. BOI acknowledged the request and said staff would be available to provide additional detail at the next meeting.
The commission lost quorum during the presentations and therefore could not take formal action; staff moved the items to the June meeting for a vote and additional analysis.
All numbers presented were BOI estimates based on carrier responses and available claims data; BOI said some estimates would be refined with additional data and carrier follow‑up ahead of the June meeting.
