Calendar Year 2023 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: January 26, 2022 Subject: Calendar Year 2023 Insulin Prescription Caps The Utah Insurance Department issues this Bulletin pursuant to Utah Code Section 31A-22-626, Coverage of Diabetes, and Utah Admin. Code R590-200, Diabetes Treatment and Management. This Bulletin notifies health insurers offering a health benefit plan of the annual inflation adjustment cap to the average wholesale price for insulin. Contracts issued or renewed during calendar year 2023 with a 30-day prescription supply must offer at least one insulin in each therapy category. The 30-day prescription supply caps are set at $27.00 for Subsection 31A-22-626(4)(a) and $90.00 for Subsection 31A-22-626(6)(b). The calculation of the insulin cap 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 through 2021. 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% 2021 $36.31 -4.1% For 2023 plans, the $30 and $100 caps in place for 2021 are adjusted as follows: 2023 cap = (2021Avg AWP/mL / 2019 Avg AWP/mL) * Base Cap or 2023 low cap = (36.31 / 40.18) * $30 = $27.11, rounded to the nearest dollar = $27 2023 high cap = (36.31/ 40.18) * $100 = $90.37, rounded to the nearest dollar = $90 The annual price of insulin provided through the Utah Insulin Savings Program, pursuant to Subsection 31A-22-626(6)(a), is available at https://www.utahinsulin.net/pdf/UtahInsulinSavingsProgramflyer.pdf. BULLETIN 2022-1 An insurer with questions related to this Bulletin is advised to contact the Health and Life Division at health.uid@utah.gov. DATED this 26th day of January 2022. ________________________________ Jonathan T. Pike Insurance Commissioner