CareFirst to Implement DC Insulin and Diabetes Device Affordability Amendment Act
Posted on 2021-09-14
Updated on 2021-09-14 15:54:07
In the December 2020 issue of BlueLink, we shared our upcoming Enhanced Diabetes Benefits that launched at the start of 2021. This benefit is part of our holistic approach to preventing and treating diabetes.
In January 2021, the DC Insulin and Diabetes Device Affordability Amendment Act was signed into law. CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. (CareFirst) will implement this mandate beginning January 1, 2022, upon contract renewal. Although the legislation was developed independently, it builds upon our current benefits.
What’s in the Mandate?
This mandate lowers the cost-share cap on a one-month supply of non-preferred brand insulin from $50 to $30. This cap will be applied regardless of the quantity or type of covered insulin used to fill the prescription. This mandate also places a $100 cost-share cap on medically necessary diabetic devices and ketoacidosis devices. These are defined as follows:
- Diabetic devices: used to cure, diagnose, mitigate, prevent, or treat diabetes or low blood sugar. Includes glucometers, continuous glucometers, lancing devices, test strips, lancets and insulin syringes.
- Diabetic ketoacidosis devices: used to screen for or prevent diabetic ketoacidosis, including those that are prescribed or dispensed once during the plan year.
In addition, any cost-sharing paid by the member for prescription insulin drugs, diabetic devices, and diabetic ketoacidosis devices may be applied to the member’s deductible.
Once a member has met their deductible, their cost-share amount will remain the same as outlined in their benefits.
Will all my patients get this new benefit?
CareFirst will be implementing this mandate for members in the following market areas:
- All Individual and Small Group ACA plans in DC
- Important Note: All ACA Catastrophic Young Adult Plans are excluded from this mandate.
- Fully insured business in DC
- All DC Grandfathered plans
CareFirst will also be implementing this mandate in certain Maryland and Northern Virginia ACA plans. Please check your patients benefits to confirm that this mandate applies to them.
Is there any other information I should know?
CareFirst has already set the cost of certain covered devices and supplies at $0. Out-of-network benefits, along with certain devices, are not subject to this mandate.
Please review your patient’s benefits in CareFirst Direct to confirm if this mandate is applicable, which devices are covered, and their cost-share amount.