2023 New Mexico Statutes › Chapter 13 - Public Purchases and Property › Article 7 - Health Care Purchasing › Section 13-7-25 - Coverage for individuals with diabetes; insulin for diabetes; cost-sharing cap.

A. Group health care coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act shall cap the amount an insured is required to pay for a preferred formulary prescription insulin drug or a medically necessary alternative at an amount not to exceed a total of twenty-five dollars ($25.00) per thirty-day supply and shall provide coverage for individuals with diabetes as required by law for each health care insurer, including:
(1) group health insurance policies, health care plans, certificates of health insurance and managed health care plans delivered or issued for delivery in New Mexico;
(2) group health plans provided through a cooperative;
(3) group health maintenance organization contracts delivered or issued for delivery in New Mexico; and
(4) health benefit plans.
B. As used in this section, "health care insurer" means a person who provides health insurance in this state, including a licensed insurance company, a licensed fraternal benefit society, a prepaid hospital or medical service plan, a health maintenance organization, a managed care organization, a nonprofit health care organization, a multiple-employer welfare arrangement or any other person providing a plan of health insurance subject to state regulation.
History:
Laws 2020, ch. 36, § 1; 2023, ch. 50, § 1.
ANNOTATIONS
The 2023 amendment,
effective June 16, 2023, required group health coverage to include coverage for individuals with diabetes, and defined "health care insurer"; in the section heading, added "Coverage for individuals with diabetes"; in Subsection A, after "thirty-day supply", added "and shall provide coverage for individuals with diabetes as required by law for each health care insurer, including", and added Paragraphs A(1) through A(4); and added Subsection B.
Applicability.
— Laws 2023, ch. 50, § 7 provided that Laws 2023, ch. 50 apply to self-insurance provided pursuant to the Health Care Purchasing Act, individual and group health insurance policies, health care plans, certificates of health insurance, managed health care plans, contracts of health insurance, group health plans provided through a cooperative, individual and group health maintenance organization contracts, health benefit plans and group health coverage that are offered, delivered or issued for delivery, renewed, extended or amended in New Mexico on or after January 1, 2024.
Temporary provisions.
— Laws 2023, ch. 50, § 6 provided:
A. By October 1, 2023, the office of superintendent of insurance shall convene a diabetes insurance coverage work group composed of:
(1) a representative of the office who shall serve as the chairperson of the working group;
(2) a representative of the New Mexico health insurance exchange who is not an employee or board member of a health insurance issuer or qualified health plan;
(3) a representative of a qualified health plan that offers a health benefit plan on the New Mexico health insurance exchange;
(4) a representative of a diabetes advisory council that represents individuals and groups across New Mexico that are trying to reduce the burden of diabetes on individuals, families, communities, the health care system and the state;
(5) a representative of a New Mexico podiatric and medical association with expertise in the treatment and management of diabetes and its complications;
(6) a representative of a New Mexico medical society with expertise in the treatment and management of diabetes and its complications;
(7) a physician specializing in the treatment and management of diabetes and its complications who is affiliated with a New Mexico medical school;
(8) a representative of the university of New Mexico health sciences center with expertise in the treatment and management of diabetes and its complications;
(9) a representative of a New Mexico advanced practice nurses' association with expertise in the treatment and management of diabetes and its complications;
(10) a person diagnosed with type 1 diabetes or family member of a person diagnosed with type 1 diabetes;
(11) a person diagnosed with type 2 diabetes or family member of a person diagnosed with type 2 diabetes;
(12) an advocate for populations disproportionately impacted by diabetes; and
(13) a representative of the risk management division of the general services department with expertise in health care insurance and finance.
B. By August 1, 2024, the work group shall report to the interim legislative health and human services committee regarding its findings and recommendations for expanding and updating New Mexico's essential health benefit benchmark plan to better address the needs of New Mexicans for services, equipment, supplies, appliances and drugs to treat and manage diabetes and its complications.