September 8, 2022
A new Washington state law caps the total amount a member is required to pay for a covered insulin drug. The amount is not to exceed $35 for a 30-day supply. The $35 insulin cost-share cap expires on January 1, 2024. This law replaces the previous $100 insulin cap legislation that expires on January 1, 2023.
The mandate applies to all Washington Individual plans, insured group plans, and PEBB/SEBB. It will be implemented as groups renew starting in January 2023. OptiFlex groups automatically include this mandate. Since the mandate intent is the same, self-funded groups who opted in to the previous $100 mandate are included in the $35 mandate at 2023 renewal. Members will continue to pay the previous $100 copay cap until the group renews in 2023.
If you have questions, contact your LifeWise account representative.