House
File
727
-
Introduced
HOUSE
FILE
727
BY
COMMITTEE
ON
HUMAN
RESOURCES
(SUCCESSOR
TO
HSB
214)
A
BILL
FOR
An
Act
relating
to
the
prescribing
and
dispensing
of
1
self-administered
hormonal
contraceptives.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
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Section
1.
Section
155A.3,
Code
2019,
is
amended
by
adding
1
the
following
new
subsections:
2
NEW
SUBSECTION
.
10A.
“Department”
means
the
department
of
3
public
health.
4
NEW
SUBSECTION
.
44A.
“Self-administered
hormonal
5
contraceptive”
means
a
self-administered
hormonal
contraceptive
6
that
is
approved
by
the
United
States
food
and
drug
7
administration
to
prevent
pregnancy.
“Self-administered
8
hormonal
contraceptive”
includes
an
oral
hormonal
contraceptive,
9
a
hormonal
vaginal
ring,
and
a
hormonal
contraceptive
patch,
10
but
does
not
include
any
drug
intended
to
induce
an
abortion
as
11
defined
in
section
146.1.
12
NEW
SUBSECTION
.
44B.
“Standing
order”
means
a
preauthorized
13
medication
order
with
specific
instructions
from
the
medical
14
director
of
the
department
to
dispense
a
medication
under
15
clearly
defined
circumstances.
16
Sec.
2.
NEW
SECTION
.
155A.47
Pharmacist
dispensing
of
17
self-administered
hormonal
contraceptives
——
standing
order
——
18
requirements
——
limitations
of
liability.
19
1.
a.
Notwithstanding
any
provision
of
law
to
the
contrary,
20
a
pharmacist
may
dispense
a
self-administered
hormonal
21
contraceptive
to
a
patient,
who
is
at
least
eighteen
years
of
22
age,
pursuant
to
a
standing
order
established
by
the
medical
23
director
of
the
department
in
accordance
with
this
section.
24
b.
In
dispensing
a
self-administered
hormonal
contraceptive
25
to
a
patient
under
this
section,
a
pharmacist
shall
comply
with
26
all
of
the
following:
27
(1)
For
an
initial
dispensing
of
a
self-administered
28
hormonal
contraceptive,
the
pharmacist
may
dispense
only
up
29
to
a
three-month
supply
at
one
time
of
the
self-administered
30
hormonal
contraceptive.
31
(2)
For
any
subsequent
dispensing
of
the
same
32
self-administered
hormonal
contraceptive,
the
pharmacist
33
may
dispense
up
to
a
twelve-month
supply
at
one
time
of
the
34
self-administered
hormonal
contraceptive.
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2.
A
pharmacist
who
dispenses
a
self-administered
hormonal
1
contraceptive
in
accordance
with
this
section
shall
not
2
require
any
other
prescription
drug
order
authorized
by
a
3
practitioner
prior
to
dispensing
the
self-administered
hormonal
4
contraceptive
to
a
patient.
5
3.
The
medical
director
of
the
department
may
establish
a
6
standing
order
authorizing
the
dispensing
of
self-administered
7
hormonal
contraceptives
by
a
pharmacist
who
does
all
of
the
8
following:
9
a.
Complies
with
the
standing
order
established
pursuant
to
10
this
section.
11
b.
Retains
a
record
of
each
patient
to
whom
a
12
self-administered
hormonal
contraceptive
is
dispensed
under
13
this
section
and
submits
the
record
to
the
department.
14
4.
The
standing
order
shall
require
a
pharmacist
who
15
dispenses
self-administered
hormonal
contraceptives
under
this
16
section
to
do
all
of
the
following:
17
a.
Complete
a
standardized
training
program
and
continuing
18
education
requirements
approved
by
the
board
in
consultation
19
with
the
board
of
medicine
and
the
department
that
are
related
20
to
prescribing
self-administered
hormonal
contraceptives
and
21
include
education
regarding
all
contraceptive
methods
approved
22
by
the
United
States
food
and
drug
administration.
23
b.
Obtain
a
completed
self-screening
risk
assessment,
24
approved
by
the
department
in
collaboration
with
the
board
and
25
the
board
of
medicine,
from
each
patient,
verify
the
identity
26
and
age
of
each
patient,
and
perform
a
blood
pressure
screening
27
on
each
patient,
prior
to
dispensing
the
self-administered
28
hormonal
contraceptive
to
the
patient.
29
c.
Provide
the
patient
with
all
of
the
following:
30
(1)
Written
information
regarding
all
of
the
following:
31
(a)
The
importance
of
completing
an
appointment
with
the
32
patient’s
primary
care
or
women’s
health
care
practitioner
33
to
obtain
preventative
care,
including
but
not
limited
to
34
recommended
tests
and
screenings.
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(b)
The
effectiveness
and
availability
of
long-acting
1
reversible
contraceptives
as
an
alternative
to
2
self-administered
hormonal
contraceptives.
3
(2)
A
copy
of
the
record
of
the
pharmacist’s
encounter
with
4
the
patient
that
includes
all
of
the
following:
5
(a)
The
patient’s
completed
self-screening
risk
assessment.
6
(b)
A
description
of
the
contraceptive
dispensed,
or
the
7
basis
for
not
dispensing
a
contraceptive.
8
(3)
Patient
counseling
regarding
all
of
the
following:
9
(a)
The
appropriate
administration
and
storage
of
the
10
self-administered
hormonal
contraceptive.
11
(b)
Potential
side
effects
and
risks
of
the
12
self-administered
hormonal
contraceptive.
13
(c)
The
need
for
backup
contraception.
14
(d)
When
to
seek
emergency
medical
attention.
15
(e)
The
risk
of
contracting
a
sexually
transmitted
16
infection
or
disease,
and
ways
to
reduce
such
a
risk.
17
5.
The
standing
order
established
pursuant
to
this
section
18
shall
prohibit
a
pharmacist
who
dispenses
a
self-administered
19
hormonal
contraceptive
under
this
section
from
doing
any
of
the
20
following:
21
a.
Requiring
a
patient
to
schedule
an
appointment
with
22
the
pharmacist
for
the
prescribing
or
dispensing
of
a
23
self-administered
hormonal
contraceptive.
24
b.
Dispensing
self-administered
hormonal
contraceptives
25
to
a
patient
for
more
than
twenty-seven
months
after
the
26
date
a
self-administered
hormonal
contraceptive
is
initially
27
dispensed
to
the
patient,
if
the
patient
has
not
consulted
with
28
a
primary
care
or
women’s
health
care
practitioner
during
the
29
preceding
twenty-seven
months,
in
which
case
the
pharmacist
30
shall
refer
the
patient
to
a
primary
care
or
women’s
health
31
care
practitioner.
32
c.
Dispensing
a
self-administered
hormonal
contraceptive
to
33
a
patient
if
the
results
of
the
self-screening
risk
assessment
34
completed
by
a
patient
pursuant
to
subsection
4,
paragraph
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“b”
,
indicate
it
is
unsafe
for
the
pharmacist
to
dispense
the
1
self-administered
hormonal
contraceptive
to
the
patient,
in
2
which
case
the
pharmacist
shall
refer
the
patient
to
a
primary
3
care
or
women’s
health
care
practitioner.
4
6.
A
pharmacist
who
dispenses
a
self-administered
hormonal
5
contraceptive
and
the
medical
director
of
the
department
who
6
establishes
a
standing
order
in
compliance
with
this
section
7
shall
be
immune
from
criminal
and
civil
liability
arising
8
from
any
damages
caused
by
the
dispensing,
administering,
9
or
use
of
a
self-administered
hormonal
contraceptive
or
the
10
establishment
of
the
standing
order.
The
medical
director
of
11
the
department
shall
be
considered
to
be
acting
within
the
12
scope
of
the
medical
director’s
office
and
employment
for
13
purposes
of
chapter
669
in
the
establishment
of
a
standing
14
order
in
compliance
with
this
section.
15
7.
The
department,
in
collaboration
with
the
board
and
16
the
board
of
medicine,
and
in
consideration
of
the
guidelines
17
established
by
the
American
congress
of
obstetricians
and
18
gynecologists,
shall
adopt
rules
pursuant
to
chapter
17A
to
19
administer
this
chapter.
20
Sec.
3.
Section
514C.19,
Code
2019,
is
amended
to
read
as
21
follows:
22
514C.19
Prescription
contraceptive
coverage.
23
1.
Notwithstanding
the
uniformity
of
treatment
requirements
24
of
section
514C.6
,
a
group
policy
,
or
contract
,
or
plan
25
providing
for
third-party
payment
or
prepayment
of
health
or
26
medical
expenses
shall
not
do
either
of
the
following
comply
27
as
follows
:
28
a.
Exclude
Such
policy,
contract,
or
plan
shall
not
29
exclude
or
restrict
benefits
for
prescription
contraceptive
30
drugs
or
prescription
contraceptive
devices
which
prevent
31
conception
and
which
are
approved
by
the
United
States
32
food
and
drug
administration,
or
generic
equivalents
33
approved
as
substitutable
by
the
United
States
food
and
34
drug
administration,
if
such
policy
,
or
contract
,
or
plan
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provides
benefits
for
other
outpatient
prescription
drugs
1
or
devices.
However,
such
policy,
contract,
or
plan
shall
2
specifically
provide
for
payment
of
a
self-administered
3
hormonal
contraceptive,
as
prescribed
by
a
practitioner
as
4
defined
in
section
155A.3,
or
as
prescribed
by
standing
order
5
and
dispensed
by
a
pharmacist
pursuant
to
section
155A.47,
6
including
payment
for
up
to
an
initial
three-month
supply
7
of
a
self-administered
hormonal
contraceptive
dispensed
at
8
one
time
and
for
up
to
a
twelve-month
supply
of
the
same
9
self-administered
hormonal
contraceptive
subsequently
dispensed
10
at
one
time.
11
b.
Exclude
Such
policy,
contract,
or
plan
shall
not
exclude
12
or
restrict
benefits
for
outpatient
contraceptive
services
13
which
are
provided
for
the
purpose
of
preventing
conception
if
14
such
policy
,
or
contract
,
or
plan
provides
benefits
for
other
15
outpatient
services
provided
by
a
health
care
professional.
16
2.
A
person
who
provides
a
group
policy
,
or
contract
,
or
17
plan
providing
for
third-party
payment
or
prepayment
of
health
18
or
medical
expenses
which
is
subject
to
subsection
1
shall
not
19
do
any
of
the
following:
20
a.
Deny
to
an
individual
eligibility,
or
continued
21
eligibility,
to
enroll
in
or
to
renew
coverage
under
the
terms
22
of
the
policy
,
or
contract
,
or
plan
because
of
the
individual’s
23
use
or
potential
use
of
such
prescription
contraceptive
drugs
24
or
devices,
or
use
or
potential
use
of
outpatient
contraceptive
25
services.
26
b.
Provide
a
monetary
payment
or
rebate
to
a
covered
27
individual
to
encourage
such
individual
to
accept
less
than
the
28
minimum
benefits
provided
for
under
subsection
1
.
29
c.
Penalize
or
otherwise
reduce
or
limit
the
reimbursement
30
of
a
health
care
professional
because
such
professional
31
prescribes
contraceptive
drugs
or
devices,
or
provides
32
contraceptive
services.
33
d.
Provide
incentives,
monetary
or
otherwise,
to
a
health
34
care
professional
to
induce
such
professional
to
withhold
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from
a
covered
individual
contraceptive
drugs
or
devices,
or
1
contraceptive
services.
2
3.
This
section
shall
not
be
construed
to
prevent
a
3
third-party
payor
from
including
deductibles,
coinsurance,
or
4
copayments
under
the
policy
,
or
contract,
or
plan
as
follows:
5
a.
A
deductible,
coinsurance,
or
copayment
for
benefits
6
for
prescription
contraceptive
drugs
shall
not
be
greater
than
7
such
deductible,
coinsurance,
or
copayment
for
any
outpatient
8
prescription
drug
for
which
coverage
under
the
policy
,
or
9
contract
,
or
plan
is
provided.
10
b.
A
deductible,
coinsurance,
or
copayment
for
benefits
for
11
prescription
contraceptive
devices
shall
not
be
greater
than
12
such
deductible,
coinsurance,
or
copayment
for
any
outpatient
13
prescription
device
for
which
coverage
under
the
policy
,
or
14
contract
,
or
plan
is
provided.
15
c.
A
deductible,
coinsurance,
or
copayment
for
benefits
for
16
outpatient
contraceptive
services
shall
not
be
greater
than
17
such
deductible,
coinsurance,
or
copayment
for
any
outpatient
18
health
care
services
for
which
coverage
under
the
policy
,
or
19
contract
,
or
plan
is
provided.
20
4.
This
section
shall
not
be
construed
to
require
a
21
third-party
payor
under
a
policy
,
or
contract
,
or
plan
22
to
provide
benefits
for
experimental
or
investigational
23
contraceptive
drugs
or
devices,
or
experimental
or
24
investigational
contraceptive
services,
except
to
the
extent
25
that
such
policy
,
or
contract
,
or
plan
provides
coverage
for
26
other
experimental
or
investigational
outpatient
prescription
27
drugs
or
devices,
or
experimental
or
investigational
outpatient
28
health
care
services.
29
5.
This
section
shall
not
be
construed
to
limit
or
otherwise
30
discourage
the
use
of
generic
equivalent
drugs
approved
by
the
31
United
States
food
and
drug
administration,
whenever
available
32
and
appropriate.
This
section
,
when
a
brand
name
drug
is
33
requested
by
a
covered
individual
and
a
suitable
generic
34
equivalent
is
available
and
appropriate,
shall
not
be
construed
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to
prohibit
a
third-party
payor
from
requiring
the
covered
1
individual
to
pay
a
deductible,
coinsurance,
or
copayment
2
consistent
with
subsection
3
,
in
addition
to
the
difference
of
3
the
cost
of
the
brand
name
drug
less
the
maximum
covered
amount
4
for
a
generic
equivalent.
5
6.
A
person
who
provides
an
individual
policy
,
or
contract
,
6
or
plan
providing
for
third-party
payment
or
prepayment
of
7
health
or
medical
expenses
shall
make
available
a
coverage
8
provision
that
satisfies
the
requirements
in
subsections
9
1
through
5
in
the
same
manner
as
such
requirements
are
10
applicable
to
a
group
policy
,
or
contract
,
or
plan
under
those
11
subsections.
The
policy
,
or
contract
,
or
plan
shall
provide
12
that
the
individual
policyholder
may
reject
the
coverage
13
provision
at
the
option
of
the
policyholder.
14
7.
a.
This
section
applies
to
the
following
classes
of
15
third-party
payment
provider
contracts
,
or
policies
,
or
plan
16
delivered,
issued
for
delivery,
continued,
or
renewed
in
this
17
state
on
or
after
July
1,
2000
January
1,
2020
:
18
(1)
Individual
or
group
accident
and
sickness
insurance
19
providing
coverage
on
an
expense-incurred
basis.
20
(2)
An
individual
or
group
hospital
or
medical
service
21
contract
issued
pursuant
to
chapter
509
,
514
,
or
514A
.
22
(3)
An
individual
or
group
health
maintenance
organization
23
contract
regulated
under
chapter
514B
.
24
(4)
Any
other
entity
engaged
in
the
business
of
insurance,
25
risk
transfer,
or
risk
retention,
which
is
subject
to
the
26
jurisdiction
of
the
commissioner.
27
(5)
A
plan
established
pursuant
to
chapter
509A
for
public
28
employees.
29
b.
This
section
shall
not
apply
to
accident-only,
30
specified
disease,
short-term
hospital
or
medical,
hospital
31
confinement
indemnity,
credit,
dental,
vision,
Medicare
32
supplement,
long-term
care,
basic
hospital
and
medical-surgical
33
expense
coverage
as
defined
by
the
commissioner,
disability
34
income
insurance
coverage,
coverage
issued
as
a
supplement
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to
liability
insurance,
workers’
compensation
or
similar
1
insurance,
or
automobile
medical
payment
insurance.
2
8.
This
section
shall
not
be
construed
to
require
a
3
third-party
payor
to
provide
payment
to
a
practitioner
for
the
4
dispensing
of
a
self-administered
hormonal
contraceptive
to
5
replace
a
self-administered
hormonal
contraceptive
that
has
6
been
dispensed
to
a
covered
person
and
that
has
been
misplaced,
7
stolen,
or
destroyed.
This
section
shall
not
be
construed
to
8
require
a
third-party
payor
to
replace
covered
prescriptions
9
that
are
misplaced,
stolen,
or
destroyed.
10
9.
For
the
purposes
of
this
section:
11
a.
“Self-administered
hormonal
contraceptive”
means
a
12
self-administered
hormonal
contraceptive
that
is
approved
13
by
the
United
Sates
food
and
drug
administration
to
prevent
14
pregnancy.
“Self-administered
hormonal
contraceptive”
includes
15
an
oral
hormonal
contraceptive,
a
hormonal
vaginal
ring,
and
16
a
hormonal
contraceptive
patch,
but
does
not
include
any
drug
17
intended
to
induce
an
abortion
as
defined
in
section
146.1.
18
b.
“Standing
order”
means
a
preauthorized
medication
order
19
with
specific
instructions
from
the
medical
director
of
the
20
department
of
public
health
to
dispense
a
medication
under
21
clearly
defined
circumstances.
22
Sec.
4.
INFORMATION
PROGRAM
FOR
DRUG
PRESCRIBING
AND
23
DISPENSING
——
SELF-ADMINISTERED
HORMONAL
CONTRACEPTIVES.
The
24
board
of
pharmacy
in
collaboration
with
the
board
of
25
medicine
and
the
department
of
public
health
shall
expand
26
the
information
program
for
drug
prescribing
and
dispensing
27
established
pursuant
to
section
124.551,
to
collect
from
28
pharmacists
information
relating
to
the
dispensing
of
29
self-administered
hormonal
contraceptives
as
provided
pursuant
30
to
section
155A.47.
The
board
of
pharmacy
shall
adopt
31
rules
pursuant
to
chapter
17A
related
to
registration
of
32
participating
pharmacists,
the
information
to
be
reported
by
a
33
pharmacist
to
the
information
program,
access
to
information
34
from
the
program,
and
other
rules
necessary
to
carry
out
the
35
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purposes
and
to
enforce
the
provisions
of
this
section.
1
EXPLANATION
2
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
3
the
explanation’s
substance
by
the
members
of
the
general
assembly.
4
This
bill
relates
to
the
dispensing
of
self-administered
5
hormonal
contraceptives
by
a
pharmacist.
The
bill
6
defines
“self-administered
hormonal
contraceptive”
as
a
7
self-administered
hormonal
contraceptive
that
is
approved
by
8
the
United
States
food
and
drug
administration
to
prevent
9
pregnancy,
including
an
oral
hormonal
contraceptive,
a
hormonal
10
vaginal
ring,
and
a
hormonal
contraceptive
patch,
but
not
11
including
any
drug
intended
to
induce
an
abortion.
12
The
bill
provides
that
notwithstanding
any
provision
of
law
13
to
the
contrary,
a
pharmacist
may
dispense
a
self-administered
14
hormonal
contraceptive
to
a
patient
who
is
at
least
18
years
15
of
age
pursuant
to
a
standing
order
established
by
the
medical
16
director
of
the
department
of
public
health
(medical
director).
17
The
bill
provides
for
an
initial
dispensing
of
only
up
to
18
a
three-month
supply
at
one
time
followed
by
a
subsequent
19
dispensing
of
up
to
a
12-month
supply
at
one
time
of
the
same
20
self-administered
hormonal
contraceptive.
Additionally,
the
21
bill
prohibits
a
pharmacist
who
dispenses
a
self-administered
22
hormonal
contraceptive
in
accordance
with
the
bill
from
23
requiring
any
other
prescription
drug
order
authorized
by
a
24
practitioner
prior
to
dispensing
the
self-administered
hormonal
25
contraceptive.
26
The
bill
authorizes
the
medical
director
to
establish
a
27
standing
order
authorizing
the
dispensing
of
self-administered
28
hormonal
contraceptives
by
any
pharmacist
who
complies
with
the
29
standing
order
and
retains
and
submits
the
patient’s
record
to
30
the
department
of
public
health
(DPH).
31
The
standing
order
includes
requiring
a
pharmacist
who
32
dispenses
a
self-administered
hormonal
contraceptive
under
33
the
bill
to:
complete
a
standardized
training
program
and
34
continuing
education
requirements
related
to
prescribing
the
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hormonal
contraceptives;
obtain
a
completed
self-screening
risk
1
assessment
from
each
patient,
verify
the
identity
and
age
of
2
each
patient,
and
perform
a
blood
pressure
screening
on
each
3
patient
before
dispensing
the
hormonal
contraceptives;
provide
4
the
patient
with
certain
written
information;
provide
the
5
patient
with
a
copy
of
the
record
of
the
pharmacist’s
encounter
6
with
the
patient;
and
provide
patient
counseling.
7
The
standing
order
is
to
prohibit
a
pharmacist
who
dispenses
8
hormonal
contraceptives
under
the
bill
from
requiring
a
9
patient
to
schedule
an
appointment
with
the
pharmacist
for
10
the
prescribing
or
dispensing
of
the
hormonal
contraceptives;
11
dispensing
the
hormonal
contraceptives
to
a
patient
for
more
12
than
27
months
after
the
date
initially
dispensed
unless
the
13
patient
has
consulted
with
a
practitioner
during
the
preceding
14
27
months
in
which
case
the
pharmacist
shall
refer
the
patient
15
to
a
primary
care
or
women’s
health
care
practitioner;
or
16
dispensing
the
hormonal
contraceptives
to
a
patient
if
the
17
results
of
the
patient’s
self-screening
risk
assessment
18
indicate
it
is
unsafe
for
the
pharmacist
to
dispense
the
19
hormonal
contraceptives
to
the
patient,
in
which
case
the
20
pharmacist
shall
refer
the
patient
to
a
practitioner.
21
The
bill
provides
immunity,
for
a
pharmacist
who
dispenses
a
22
self-administered
hormonal
contraceptive
and
for
the
medical
23
director
who
establishes
a
standing
order
in
compliance
with
24
the
bill,
from
criminal
and
civil
liability
arising
from
any
25
damages
caused
by
the
dispensing,
administering,
or
use
of
a
26
self-administered
hormonal
contraceptive
or
the
establishment
27
of
the
standing
order.
Additionally,
the
medical
director
28
shall
be
considered
to
be
acting
within
the
scope
of
the
29
medical
director’s
office
and
employment
for
purposes
of
Code
30
chapter
669
(Iowa
tort
claims
Act)
in
the
establishment
of
a
31
standing
order
in
compliance
with
the
bill.
32
The
bill
requires
DPH,
in
collaboration
with
the
boards
of
33
pharmacy
and
medicine,
and
in
consideration
of
the
guidelines
34
established
by
the
American
congress
of
obstetricians
and
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gynecologists,
to
adopt
administrative
rules
to
administer
the
1
bill.
2
The
bill
amends
prescription
contraceptive
coverage
3
provisions
to
require
that
a
group
policy,
contract,
or
plan
4
delivered,
issued
for
delivery,
continued,
or
renewed
in
the
5
state
on
or
after
January
1,
2020,
providing
for
third-party
6
payment
or
prepayment
of
health
or
medical
expenses,
shall
7
specifically
provide
for
payment
of
self-administered
hormonal
8
contraceptives,
as
prescribed
and
dispensed
as
specified
in
9
the
bill,
including
those
dispensed
at
one
time.
The
bill
10
provides,
however,
that
the
provisions
of
the
bill
relating
11
to
coverage
are
not
to
be
construed
to
require
a
third-party
12
payor
to
provide
payment
to
a
practitioner
for
dispensing
13
a
self-administered
hormonal
contraceptive
to
replace
a
14
self-administered
hormonal
contraceptive
that
has
been
15
dispensed
to
a
covered
person
and
that
has
been
misplaced,
16
stolen,
or
destroyed.
These
provisions
are
also
not
to
be
17
construed
to
require
a
third-party
payor
to
replace
covered
18
prescriptions
that
are
misplaced,
stolen,
or
destroyed.
19
The
bill
requires
the
board
of
pharmacy
in
collaboration
20
with
the
board
of
medicine
and
the
department
of
public
health
21
to
expand
the
information
program
for
drug
prescribing
and
22
dispensing
to
collect
information
from
pharmacists
relating
to
23
the
dispensing
of
self-administered
hormonal
contraceptives
as
24
provided
under
the
bill.
25
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