Bill > HB53

This bill aims to update coverage for individuals with diabetes in New Mexico. The key provisions are: 1. Requires group health insurance plans, self-insured plans, health maintenance organizations, and nonprofit health care plans to provide comprehensive coverage for individuals with insulin-using diabetes, non-insulin-using diabetes, and elevated blood glucose levels induced by pregnancy. This includes coverage for necessary equipment, supplies, appliances, insulin, and diabetes self-management training, among other benefits. 2. Caps the amount an individual with diabetes must pay for a 30-day supply of a preferred formulary prescription insulin drug or medically necessary alternative at $25. 3. Requires insurers to maintain adequate networks of durable medical equipment suppliers and monitor timely delivery of necessary diabetes resources to enrollees. Provides for reimbursement and interest payments if resources are not delivered on time. 4. Establishes reporting requirements for insurers on metrics related to timely delivery and reimbursement of diabetes resources. 5. Prohibits excessive prior authorization requirements for diabetes medications and supplies if prescribed as medically necessary. 6. Convenes a work group to examine and make recommendations for updating New Mexico's essential health benefit benchmark plan to better address diabetes care. The bill aims to ensure consistent and timely access to necessary diabetic resources for individuals with diabetes in New Mexico.

Health and Social Services

https://www.nmlegis.gov/Legislation/Legislation?chamber=H&legtype=B&legno=53&year=23