<?xml version='1.0' encoding='utf-8'?>
<section article="gin" article_name="Insurance" number="15-822.1" title_number="15" title_name="Health Insurance" subtitle_number="8" subtitle_name="Required Health Insurance Benefits">
  <level label="a">
    <level label="1">
      <text>This section applies to:</text>
      <level label="i">
        <text>insurers and nonprofit health service plans that provide coverage for prescription drugs and devices to individuals or groups under health insurance policies or contracts that are delivered in the State; and</text>
      </level>
      <level label="ii">
        <text>health maintenance organizations that provide coverage for prescription drugs and devices to individuals or groups under contracts that are issued or delivered in the State.</text>
      </level>
    </level>
    <level label="2">
      <text>An insurer, a nonprofit health service plan, or a health maintenance organization that provides coverage for prescription drugs and devices through a pharmacy benefits manager is subject to the requirements of this section.</text>
    </level>
  </level>
  <level label="b">
    <text>An entity subject to this section shall limit the amount a covered individual is required to pay in copayments or coinsurance for a covered prescription insulin drug to not more than $30 for a 30–day supply, regardless of the amount or type of insulin needed to fill the covered individual’s prescription.</text>
  </level>
  <level label="c">
    <text>An entity subject to this section may set the amount a covered individual is required to pay to an amount that is less than the payment amount limit under subsection (b) of this section.</text>
  </level>
  <level label="d">
    <text>A contract between an entity subject to this section, or a pharmacy benefits manager through which the entity provides coverage for prescription drugs and devices, and a pharmacy or the pharmacy’s contracting agent, may not:</text>
    <level label="1">
      <text>authorize a party to the contract to charge a covered individual an amount that is more than the payment amount limit under subsection (b) of this section;</text>
    </level>
    <level label="2">
      <text>require a pharmacy to collect from a covered individual an amount that is more than the payment amount limit under subsection (b) of this section; or</text>
    </level>
    <level label="3">
      <text>require a covered individual to pay an amount that is more than the payment amount limit under subsection (b) of this section.</text>
    </level>
  </level>
</section>
