Calendar Year 2022 Insulin Prescription Caps

4315 South 2700 West, Suite 2300, Taylorsville, Utah 84129 ● Office (801) 957-9200 ● Facsimile (385) 465-6047 ● insurance.utah.gov State of Utah SPENCER J. COX Governor DEIDRE M. HENDERSON Lieutenant Governor Insurance Department JONATHAN T. PIKE Insurance Commissioner To: Insurers Offering a Health Benefit Plan From: Jonathan T. Pike, Utah Insurance Commissioner Date: May 26, 2021 Subject: Calendar Year 2022 Insulin Prescription Caps The Utah Insurance Department issues this Bulletin to provide to health insurers offering a health benefit plan the annual inflationary adjustment to the caps for the average wholesale price of insulin sold in Utah, pursuant to Section 31A-22-626, Coverage of Diabetes, and Rule R590- 200, Diabetes Treatment and Management. Per Subsection 31A-22-626(9), for contracts issued or renewed during calendar year 2022, the insulin prescription cap for a 30-day prescription supply of at least one insulin in each therapy category is set at $28.00 for Subsection 31A-22-626(4)(a) and $94.00 for Subsection 31A-22- 626(6)(b). The calculation of the insulin caps is based on data provided by the Public Employees Health Plan (PEHP). PEHP calculated the Average Wholesale Price per Milliliter (AWP/mL) of insulin for calendar years 2019 and 2020. PEHP included all modes of insulin and all therapy categories in the calculation of the average AWP/mL. Calendar Year Avg AWP/mL % change in AWP/mL 2019 $40.18 n/a 2020 $37.85 -5.8% For 2022 plans, the $30 and $100 caps in place for 2021 are adjusted as follows: 2022 cap = 2021 cap * ([2020 Avg AWP/mL] / [2019 Avg AWP/mL]) or 2022 low cap = $30 * 37.85 / 40.18 = $28.33, rounded to the nearest dollar = $28 2022 high cap = $100 * 37.85 / 40.18 = $94.20, rounded to the nearest dollar = $94 BULLETIN 2021-4