SF 2113 (LSB 5562XS (1) 88)

SENATE FILE 2113

BY  KOELKER

A BILL FOR

An Act relating to insurance coverage for prescription insulin drugs.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  NEW SECTION.  514C.18A  Prescription insulin drugs —— coverage.
   1.  As used in this section, unless the context otherwise requires:
   a.  “Cost-sharing” means any coverage limit, copayment, coinsurance, deductible, or other out-of-pocket expense obligation imposed on a covered person by a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses.
   b.  “Covered person” means a policyholder, subscriber, or other person participating in a policy, contract, or plan that provides for third-party payment or prepayment of health or medical expenses. 
   c.  “Health care professional” means the same as defined in section 514J.102.
   d.  “Prescription insulin drug” means a prescription drug that contains insulin, is used to treat diabetes, and that has been prescribed as medically necessary by a covered person’s health care professional. 
   2.  Notwithstanding the uniformity of treatment requirements of section 514C.6, a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses that provides coverage for prescription drugs shall cap the total amount of cost-sharing that a covered person is required to pay for a prescription insulin drug to an amount not to exceed one hundred dollars per thirty-day supply of the prescription insulin drug, regardless of the amount or type of prescription insulin drug required to fill the covered person’s prescription. 
   3.  Nothing in this section shall be construed to prohibit a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses from reducing a covered person’s cost-sharing obligation by an amount greater than the amount specified pursuant to subsection 2.
   4.  a.  This section shall apply to the following classes of third-party payment provider contracts, policies, or plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2021:
   (1)  Individual or group accident and sickness insurance providing coverage on an expense-incurred basis.
   (2)  An individual or group hospital or medical service contract issued pursuant to chapter 509, 514, or 514A.
   (3)  An individual or group health maintenance organization contract regulated under chapter 514B.
   (4)  A plan established for public employees pursuant to chapter 509A.
   b.  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 of insurance, disability income insurance coverage, coverage issued as a supplement to liability insurance, workers’ compensation or similar insurance, or automobile medical payment insurance.
   5.  The commissioner of insurance shall adopt rules pursuant to chapter 17A to administer this section.
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 prescription insulin drugs and coverage by policies, contracts, or plans providing for third-party payment or prepayment of health or medical expenses that provide coverage for prescription drugs.
   The bill requires a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses that provides coverage for prescription drugs to cap the total amount of cost-sharing that a covered person is required to pay for a prescription insulin drug to an amount not more than $100 for a 30-day supply, regardless of the amount or type of prescription insulin drug required to fill the covered person’s prescription. “Prescription insulin drug” is defined in the bill as a prescription drug that contains insulin, is used to treat diabetes, and that has been prescribed as medically necessary by a covered person’s health care professional. The bill defines “cost-sharing” as any coverage limit, copayment, coinsurance, deductible, or other out-of-pocket expense imposed on a covered person.
   The bill does not prohibit a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses from reducing a covered person’s cost-sharing to less than $100 for a 30-day supply of a prescription insulin drug.
   The bill applies to third-party payment provider contracts, policies, or plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2021, by the third-party payment providers enumerated in the bill. 
   The bill specifies the types of specialized health-related insurance which are not subject to the coverage requirements of the bill.
   The commissioner of insurance is required to adopt rules to administer the requirements of the bill.