HB249 Alabama 2021 Session

Summary

Primary Sponsor

Paul W. LeeRepresentative

Republican

Session

Regular Session 2021

Title

Health benefit plans, insulin prescription drugs, co-pay limited, Secs. 10A-20-6.16, 27-21A-23 am'd.

Summary

HB249 would cap insulin prescription drug copays at $100 per 30-day supply for Alabama health benefit plans, with annual CPI-based increases, and updates related law for insurers and HMOs.

What This Bill Does

The bill requires health benefit plans that cover prescription insulin drugs to cap cost-sharing at $100 for a 30-day supply, with the cap increasing each January 1 by the change in the prescription-drug portion of the CPI. Plans can set lower copays if they choose, and the cap applies regardless of deductible or insulin type. It also amends Alabama law sections 10A-20-6.16 and 27-21A-23 to define scope, regulate HMOs, and clarify exemptions for self-funded plans; it also provides an actuarial-value exemption. It applies to contracts entered after the act’s effective date, October 1, 2021, and excludes cases where raising other cost-sharing is needed to meet actuarial standards.

Who It Affects

• Individuals and families enrolled in Alabama health benefit plans that cover prescription insulin drugs will pay no more than $100 for a 30-day insulin supply (subject to CPI increases).
• Health benefit plan issuers, insurers, HMOs, and self-funded plan administrators in Alabama; they must implement the cap and are subject to amended regulations, with self-funded plans administered by a company potentially exempt from some requirements.

Key Provisions

• Insulin copay cap: $100 per 30-day supply; applies regardless of deductible or insulin amount; annual CPI-based increase.
• Definitions added for scope: health benefit plan and prescription insulin drug.
• Effective date and contract timing: cap applies to contracts entered after October 1, 2021; actuarial-value exemptions may apply if needed to meet standards.
• Regulatory alignment: amends 10A-20-6.16 and 27-21A-23 to address self-funded plans, HMOs, and related regulatory requirements.

AI-generated summary using openai/gpt-5-nano on Feb 22, 2026. May contain errors — refer to the official bill text for accuracy.

Subjects

Health Benefit Plans