H.F. _____ Section 1. NEW SECTION . 514C.26 Medication therapy 1 management coverage. 2 1. As used in this section: 3 a. “Commissioner” means the commissioner of insurance. 4 b. “Medication therapy management” means a systematic 5 process performed by a licensed pharmacist, designed to 6 optimize therapeutic outcomes through improved medication use 7 and reduced risk of adverse drug events, including all of the 8 following services: 9 (1) A medication therapy review of all medications 10 currently being taken by an individual. 11 (2) A medication action plan communicated to the 12 individual and the individual’s primary care physician 13 or other appropriate prescriber to address safety issues, 14 inconsistencies, duplicative therapy, omissions, and medication 15 costs. The medication action plan may include recommendations 16 to the prescriber for changes in drug therapy. 17 (3) Documentation and follow-up to ensure consistent levels 18 of pharmacy services and positive outcomes. 19 2. Notwithstanding the uniformity of treatment requirements 20 of section 514C.6, a contract, policy, or plan providing 21 for third-party payment or prepayment for health or medical 22 expenses that include pharmaceutical benefits shall provide 23 coverage for medication therapy management in accordance 24 with rules adopted by the commissioner. The provisions of 25 this section shall apply to all of the following classes of 26 third-party payment provider contracts, policies, or plans 27 delivered, issued for delivery, continued, or renewed in this 28 state on or after July 1, 2010: 29 a. Individual or group accident and sickness insurance 30 providing coverage on an expense-incurred basis. 31 b. An individual or group hospital or medical service 32 contract issued pursuant to chapter 509, 514, or 514A. 33 c. An individual or group health maintenance organization 34 contract regulated under chapter 514B. 35 -1- LSB 5295YC (1) 83 pf/rj 1/ 3

H.F. _____ d. An individual or group Medicare supplemental policy, 1 unless coverage pursuant to such policy is preempted by federal 2 law. 3 e. A plan established pursuant to chapter 509A for public 4 employees. 5 3. This section shall not apply to accident-only, specified 6 disease, short-term hospital or medical, hospital confinement 7 indemnity, credit, dental, vision, long-term care, basic 8 hospital, and medical-surgical expense coverage as defined 9 by the commissioner, disability income insurance coverage, 10 coverage issued as a supplement to liability insurance, 11 workers’ compensation or similar insurance, or automobile 12 medical payment insurance. 13 4. The commissioner shall adopt rules pursuant to chapter 14 17A regarding coverage of benefits for medication therapy 15 management based on all of the following: 16 a. Medication therapy management shall be a covered benefit 17 for any of the following individuals: 18 (1) An individual who takes four or more prescription drugs 19 to treat or prevent two or more chronic medical conditions. 20 (2) An individual who has a prescription drug therapy 21 problem as identified by the prescribing physician or other 22 appropriate prescriber, and is referred to a pharmacist for 23 medication therapy management. 24 (3) An individual who meets other criteria established by 25 the commissioner by rule in consultation with the director of 26 public health. 27 (4) An individual who meets other criteria established by 28 the third-party payment provider contract, policy, or plan 29 which is not inconsistent with or more restrictive than the 30 criteria otherwise specified in this paragraph “a” . 31 b. Reimbursement of medication therapy management services 32 shall be separate from the reimbursement for prescription drug 33 product or dispensing services; shall be determined by each 34 third-party payment provider contract, policy, or plan; and 35 -2- LSB 5295YC (1) 83 pf/rj 2/ 3

H.F. _____ shall be reasonably based on the resources and time required 1 to provide the services. 2 c. If any part of the medication therapy management 3 services provided by a pharmacist incorporates services which 4 are outside the pharmacist’s independent scope of practice 5 including the initiation of therapy, modification of dosages, 6 therapeutic interchange, or changes in drug therapy, the 7 express authorization of the individual’s physician or other 8 appropriate prescriber is required. Express authorization 9 includes but is not limited to a collaborative practice 10 agreement. 11 EXPLANATION 12 This bill relates to medication therapy management. The 13 bill defines “medication therapy management” and provides that 14 a contract, policy, or plan providing for third-party payment 15 or prepayment which includes coverage for health or medical 16 expenses that includes pharmaceutical benefits shall provide 17 coverage for medication therapy management in accordance 18 with rules adopted by the commissioner of insurance. The 19 bill specifies the classes of third-party payment provider 20 contracts, policies, or plans delivered, issued for delivery, 21 continued, or renewed in this state on or after July 1, 2010, 22 that must include or that are exempt from providing coverage 23 for medication therapy management. The bill directs the 24 commissioner of insurance to adopt rules pursuant to Code 25 chapter 17A regarding coverage of benefits for medication 26 therapy management based on specific provisions. 27 -3- LSB 5295YC (1) 83 pf/rj 3/ 3