SD21 - Coverage for Medication for Diabetes

  • Published: 2001
  • Author: Special Advisory Commission on Mandated Health Insurance Benefits
  • Enabling Authority: Code of Virginia - § 9-298

Executive Summary:
INTRODUCTION

Senate Bill 466 was referred to the Special Advisory Commission on Mandated Health Insurance Benefits (Advisory Commission) by the Senate Committee on Commerce and labor in the 2000 Session of the General Assembly. Senator Charles J. Colgan introduced the bill.

The Advisory Commission held a public hearing to receive comments on the bill in Richmond on August 3, 2000. The patron, Senator Colgan, spoke in support of the bill. Representatives of the Virginia Association of Health Plans (VAHP) and the Health Insurance Association of America spoke against the bill. Written comments in support of the bill were received from the Virginia Affiliate of the American Diabetes Association, along with information from the national association and a proponent of the legislation. Written comments in opposition to the bill were received from the VAHP.

The Advisory Commission concluded its review of the bill on August 30, 2000.

SUMMARY OF PROPOSED LEGISLATION

The bill amends and reenacts § 38.2-3418.10 in the accident and sickness provisions chapter. The section applies to insurers proposing to issue an individual or group hospital policy or major medical policy in this Commonwealth; each corporation proposing to issue an individual or group hospital, medical or major medical subscription contract; and each health maintenance organization (HMO) providing a health care plan for such services.

The bill requires benefits for medications approved by the federal Food and Drug Administration (FDA). This is in addition to equipment, supplies, and outpatient self-management training and education, including medical nutrition therapy for the treatment of insulin-dependent diabetes, insulin-using diabetes, gestational diabetes, and non-insulin-using diabetes, if prescribed by a health care professional legally authorized to prescribe such items under law, which is already required by the section.

The current language in § 38.2-3418.10 requires that any insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis; each corporation providing individual or group accident and sickness subscription contracts; and each health maintenance organization providing a health care plan for health care services provide coverage for diabetes as provided in this section.

The coverage must include benefits for equipment, supplies, and outpatient self-management training and education, including medical nutrition therapy for the treatment of insulin-dependent diabetes, insulin-using diabetes, gestational diabetes, and non-insulin using diabetes, if prescribed by a health care professional legally authorized to prescribe such items under law. Diabetes outpatient self-management training and education must be provided by a certified, registered, or licensed health care provider to qualify for coverage under the section.

Insurers, corporations, or HMOs cannot impose upon any person receiving benefits pursuant to this section any co-payment, fee, or condition that is not equally imposed upon all individuals in the same benefit category. The section does not apply to short-term travel, accident only, limited or specified disease, or individual conversion policies or contracts, nor to policies or contracts designed for issuance to persons eligible for similar coverage under state or federal governmental plans. The section applies to all insurance policies, contracts, and plans delivered, issued for delivery, reissued, or extended on and after July 1, 1999, or at any time thereafter when any term of the policy, contract, or plan is changed or any premium adjustment is made.

The bill, as introduced, appears to mandate coverage for prescription drugs in policies and plans that do not otherwise provide prescription drug coverage. Prescription drug coverage is usually provided separately by rider for all covered pharmaceuticals and not for a particular medication.

Senator Colgan proposed amended language at the August 3 meeting. The new language stated: "Coverage by those entities described in subsection A that provide prescription drug benefits shall also include coverage of medications approved by the federal Food and Drug Administration for diabetes treatment, if prescribed by a health care professional legally authorized to prescribe such medication under law. Coverages under this subsection may be provided in accordance with § 38.2-3407.90:01." This amended language is found in Appendix B.