HF 2499 (LSB 5494HV (1) 88)

HOUSE FILE 2499

BY  COMMITTEE ON HUMAN RESOURCES

(SUCCESSOR TO HSB 582)

A BILL FOR

An Act relating to dispensing fees and copayments for partially dispensed quantities of prescription drugs.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  NEW SECTION.  155A.38A  Prescriptions dispensed in partial quantities —— limitation on dispensing fee and copayments.
   1.  If a person authorized pursuant to this chapter to dispense prescription drugs initially dispenses a partial quantity of a thirty-day supply of a prescription drug and subsequently dispenses the remaining quantity as authorized by the prescription within thirty days of the initial dispensing, all of the following shall apply:
   a.  The cumulative dispensing fee applicable to all partially dispensed quantities of the prescription drug shall not exceed the established dispensing fee applicable as if the total quantity prescribed had been dispensed at one time. 
   b.  The cumulative copayment required for all partially dispensed quantities of the prescription drug shall not exceed the established copayment applicable as if the total quantity prescribed had been dispensed at one time.
   2.  This section shall apply whether the partial dispensing of a quantity authorized by a prescription is due to a policy of the authorized dispenser, a requirement of the third-party payment provider contract or policy, a supply deficit, or for any other reason.
    Sec. 2.  NEW SECTION.  514C.35  Prescriptions dispensed in partial quantities —— limitation on dispensing fee and copayments.
   1.  Third-party payment provider contracts or policies delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2021, that provide for third-party payment or prepayment of health or medical expenses shall provide that if a person authorized pursuant to chapter 155A to dispense initially dispenses a partial quantity of a thirty-day supply of a prescription drug and subsequently dispenses the remaining quantity as authorized by the prescription within thirty days of the initial dispensing, all of the following shall apply:
   a.  The cumulative dispensing fee applicable to all partially dispensed quantities of the prescription drug shall not exceed the established dispensing fee applicable as if the total quantity prescribed had been dispensed at one time.
   b.  The cumulative copayment required for all partially dispensed quantities of the prescription drug shall not exceed the established copayment applicable as if the total quantity prescribed had been dispensed at one time.
   2.  This section shall apply whether the partial dispensing of a quantity authorized by a prescription is due to a policy of the authorized dispenser, a requirement of the third-party payment provider contract or policy, a supply deficit, or for any other reason.
   3.  For the purposes of this section, “third-party payment provider contracts or policies” includes:
   a.  Individual or group accident and sickness insurance providing coverage on an expense-incurred basis.
   b.  An individual or group hospital or medical service contract issued pursuant to chapter 509, 514, or 514A.
   c.  An individual or group health maintenance organization contract regulated under chapter 514B.
   d.  Any other entity engaged in the business of insurance, risk transfer, or risk retention, which is subject to the jurisdiction of the commissioner.
   e.  A plan established pursuant to chapter 509A for public employees.
   4.  a.  This section shall not apply to accident-only, specified disease, short-term hospital or medical, hospital confinement indemnity, credit, dental, vision, Medicare supplement, long-term care, basic hospital and medical-surgical expense coverage as defined by the commissioner, disability income insurance coverage, coverage issued as a supplement to liability insurance, workers’ compensation or similar insurance, or automobile medical payment insurance. 
   b.  This section shall not apply to the medical assistance program pursuant to chapter 249A, including to a managed care organization acting pursuant to a contract with the department of human services to provide coverage to medical assistance program members, or to the hawk-i program pursuant to chapter 514I.
    Sec. 3.  MEDICAID PROGRAM —— DISPENSING FEE AND COPAYMENTS FOR PRESCRIPTIONS DISPENSED IN PARTIAL QUANTITIES.
   1.  The department of human services shall adopt rules pursuant to chapter 17A to require that if a Medicaid provider, under both fee-for-service and managed care program administration, who is authorized to dispense prescription drugs pursuant to chapter 155A, initially dispenses a partial quantity of a thirty-day supply of a prescription drug and subsequently dispenses the remaining quantity as authorized by the prescription, all of the following shall apply:
   a.  The cumulative dispensing fee applicable to all partially dispensed quantities of the prescription drug shall not exceed the established dispensing fee applicable as if the total quantity prescribed had been dispensed at one time.
   b.  The cumulative copayment required for all partially dispensed quantities of the prescription drug shall not exceed the established copayment applicable as if the total quantity prescribed had been dispensed at one time.
   2.  This section shall apply whether the partial dispensing of a quantity authorized by a prescription is due to a policy of the authorized dispenser, a requirement of a managed care organization or third-party payment provider contract or policy, a supply deficit, or for any other reason.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to the dispensing of prescription drugs in partial quantities.
   The bill provides that if a person authorized to dispense prescription drugs under Code chapter 155A initially dispenses a partial quantity of a 30-day supply of a prescription drug and subsequently dispenses the remaining quantity as authorized by the prescription within 30 days of the initial dispensing, the cumulative dispensing fee applicable to all partially dispensed quantities of the prescription drug shall not exceed the established dispensing fee applicable as if the total quantity prescribed had been dispensed at one time, and the cumulative copayment required for all partially dispensed quantities of the prescription drug shall not exceed the established copayment applicable as if the total quantity prescribed had been dispensed at one time. These requirements apply whether the partial dispensing of a quantity authorized by a prescription is due to a policy of the authorized dispenser, a requirement of the third-party payment provider contract or policy, a supply deficit, or for any other reason. The bill directs the department of human services to adopt administrative rules to require Medicaid providers to comply with these provisions, whether the partial dispensing of the quantity authorized by the prescription is due to a policy of the authorized dispenser, a requirement of a managed care organization or third-party payment provider contract or policy, a supply deficit, or for any other reason. The requirement applies under both fee-for-service and managed care program administration of Medicaid.
   Similarly, the bill provides that any third-party payment provider contracts or policies delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2021, that provide for third-party payment or prepayment of health or medical expenses shall provide that if a person authorized pursuant to Code chapter 155A to dispense initially dispenses a partial quantity of a 30-day supply of a prescription drug and subsequently dispenses the remaining quantity as authorized by the prescription within 30 days of the initial dispensing, the cumulative dispensing fee applicable to all partially dispensed quantities of the prescription drug shall not exceed the established dispensing fee applicable as if the total quantity prescribed had been dispensed at one time, and the cumulative copayment required for all partially dispensed quantities of the prescription drug shall not exceed the established copayment applicable as if the total quantity prescribed had been dispensed at one time. The provision applies whether the partial dispensing of a quantity authorized by a prescription is due to a policy of the authorized dispenser, a requirement of the third-party payment provider contract or policy, a supply deficit, or for any other reason.