UT| Bulletin 2025-3 from the Utah Insurance Department, outlines updated insulin prescription caps for health benefit plans issued or renewed in the 2026 calendar year.
Key Points:
- Caps on Insulin Costs: Insurers must offer at least one insulin per therapy category with a 30-day supply cap set at $10.00 (low cap) and $35.00 (high cap), adjusted for inflation using data from the Public Employees Health Plan (PEHP).
- Calculation Methodology: The caps are calculated based on the ratio of the 2024 average wholesale price per milliliter (AWP/mL) of insulin ($14.54) to the 2019 AWP/mL ($40.18), and rounded to the nearest multiple of $5.
- Insulin Savings Program: Details about the Utah Insulin Savings Program, which provides affordable annual insulin pricing, are available online at utahinsulin.net.