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25 chapters · 212 sections in this title.
D.C. Code § 48-855.01 Definitions
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For the purposes of this chapter, the term: (1) "Class of drugs" means a group of medications having similar actions designed to treat a particular disease process. (2) "Coinsurance" means a cost-sharing amount set as a percentage of the total cost of a drug. (3) "Copayment" mean…
D.C. Code § 48-855.02 Specialty drug copayment or coinsurance limitation
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(a)(1) A health benefit plan that provides coverage for prescription drugs shall ensure that a required copayment or coinsurance applicable to a drug on a specialty tier does not exceed $150 per month for up to a 30-day supply of the specialty drug or $300 for a 90-day supply. (2…
D.C. Code § 48-855.02a Insulin copayment or coinsurance limitation
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(a) A health insurer that provides coverage for prescription insulin drugs pursuant to the terms of a health benefits plan the insurer offers shall limit the total amount that an insured is required to pay for a 30-day supply of covered prescription insulin drugs at an amount not…
D.C. Code § 48-855.02b Calculation of member's contributions for a prescription drug covered under the health benefit plan
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(a) Except as otherwise provided in subsection (b) of this section, when calculating a member's contribution to their coinsurance, copayment, cost-sharing responsibility, deductible, or out-of-pocket maximum under the member's health benefit plan, the health insurer shall include…
