An Act To Save Lives by Capping the Out-of-pocket Cost of Certain Medications
Maine Legislature, Session 129, LD 2096
Committee Amendment CA_A_H772 (House)
Amends: 24-A MRSA §4317-C, 32 MRSA §13786-D

COMMITTEE AMENDMENT ,.;J" to H.P. 1493, L.D. 2096, Bill, "An Act To 
Save Lives by Capping the Out-of-pocket Cost of Certain Medications" 
Amend the bill by striking out everything after the enacting clause and inserting the 
following: 
'PART A 
Sec. A-1. 24-A MRSA §4317-C is enacted to read: 
§4317-C. Coverage for prescription insulin drugs; limit on out-of-pocket costs 
1. Definition. As used in this section, "insulin" has the same meaning as in Title 32. 
section 13786-D. subsection 1. paragraph A. 
2. Limit on out-of-pocket costs. A carrier that provides coverage for prescription 
insulin drugs may not impose any deductible. copayment. coinsurance or other cost-
sharing requirement on an enrollee for that coverage that results in out-of-pocket costs to 
the enrollee that exceed $35 per prescription for a 30-day supply of covered prescription 
insulin drugs. regardless of the amount of insulin needed to fill the enrollee's insulin 
prescriptions. 
3. Other cost sharing. This section does not prevent a carrier from setting an 
enrollee's cost-sharing requirement for one or more insulin drugs at an amount lower than 
the maximum amount specified in this section. 
4. Rules. The superintendent may adopt rules to implement and administer this 
section to align with applicable federal requirements. Rules adopted pursuant to this 
section are routine technical rules as defined in Title 5, chapter 375. subchapter 2-A. 
Sec. A-2. Application. 
The requirements of this Part apply to all policies, 
contracts and certificates executed, delivered, issued for delivery, continued or renewed 
in this State on or after January 1, 2021. For purposes of this Act, all contracts are 
deemed to be renewed no later than the next yearly anniversary of the contract date. 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT ,A,, to H.P. 1493, L.D. 2096 
PARTB 
Sec. B-1. 32 MRSA §13786-D is enacted to read: 
§13786-D. Prescribing and dispensing insulin 
1. Definitions. As used in this section, unless the context otherwise indicates, the 
following terms have the following meanings. 
A. "Insulin" includes various types of insulin analogs and insulin-like medications, 
regardless of activation period or whether the solution is mixed before or after 
dispensation. 
B. "Insulin-related devices and sup_plies" means needles, syringes, cartridge systems, 
prefilled pen systems, glucose meters and test strips. "Insulin-related devices and 
sup_plies" does not include insulin pump devices. 
2. Authorization. As authorized by the board in accordance with rules adopted 
under subsection 3, a pharmacist may dispense emergency refills of insulin and 
associated insulin-related devices and sup_plies by prescription drug order or standing 
order or pursuant to a collaborative practice agreement authorizing insulin to be 
dispensed. The insulin dispensed under this subsection must be in a quantity that is the 
lesser of a 30-day sup_ply and the smallest available package. The intended recipient shall 
provide evidence of a previous prescription from a practitioner and attest that a refill of 
that previous prescription may not be readily or easily obtained under the circumstances. 
3. Rules; protocols. The board by rule shall establish standards for authorizing 
pharmacists to dispense insulin in accordance with subsection 2, including adequate 
training requirements and protocols for dispensing insulin. Rules adopted under this 
subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A.' 
Amend the bill by relettering or renumbering any nonconsecutive Part letter or 
section number to read consecutively. 
SUMMARY 
This amendment replaces the bill. Part A provides that a health insurance carrier that 
provides coverage for prescription insulin drugs may not impose a cost-sharing 
requirement on an enrollee that results in out-of-pocket costs to the enrollee in excess of 
$35 per prescription for a 30-day supply of insulin. The requirements apply to all health 
insurance policies issued or renewed on or after January 1, 2021. 
Part B authorizes a phannacist to dispense emergency refills of insulin and associated 
insulin-related supplies. The amendment requires that the insulin dispensed be in a 
quantity that is the lesser of a 30-day supply and the smallest available package. The 
amendment also requires the Maine Board of Pharmacy to adopt rules to establish 
adequate training requirements and protocols for dispensing insulin. 
:FISCAL l'\OTE REQUIRED. 
· · 
J§,~eattached)_ 
COMMITTEE AMENDMENT 
Approved: 03/16/20 ;wac;. 
LD 2096 
LR 3128(02) 
An Act To Save Lives by Capping the Out-of-pocket Cost of Certain Medications 
Fiscal Note for Bill as Amended by Committee Amendment i/J,{ /I-"' J)J) 
Committee: Health Coverage, Insurance and Financial Services 
Fiscal Note Required: Yes 
Fiscal Note 
Minor cost increase - All funds 
Fiscal Detail and Notes 
The bill provides that a health insurance carrier may not impose a cost-shating requirement in excess of $35 for 
insulin drugs for a 30 day supply. The Maine State Employee Health Plan has indicated that it does not anticipate a 
significant increase in costs as a result of this cost-sharing limit given the amounts that are cunently charged. Any 
costs, which are expected to be minor, would likely be reflected through increased premium amounts in future fiscal 
years. 
Additional costs to the Department of Professional and Financial Regulation and the Maine Board of Phannacy 
associated with the rulemaking process can be absorbed within existing budgeted resources. 
LR3128(02) - Fiscal Note - Page 1 of 1