S.F. 2216 Section 1. NEW SECTION . 514C.4A Diagnostic examinations 1 —— breast cancer. 2 1. As used in this section, unless the context otherwise 3 requires: 4 a. “Abnormality” means an abnormal feature, characteristic, 5 or occurrence in a covered person’s breast that meets any of 6 the following requirements: 7 (1) The abnormality is identified as a result of a covered 8 person’s screening mammogram. 9 (2) The abnormality is identified during the provision 10 of health care services to a covered person by a health care 11 professional. 12 (3) A health care professional determines an abnormality 13 exists based on a covered person’s medical history or the 14 covered person’s family medical history. 15 b. “Breast magnetic resonance imaging” or “breast MRI” means 16 an examination of a breast using a powerful magnetic field, 17 radio waves, and a computer to produce detailed pictures of the 18 structures within the breast. 19 c. “Breast ultrasound” means an examination of a breast 20 using sound waves to produce pictures of the internal 21 structures of the breast. 22 d. “Cost-sharing” means any coverage limit, copayment, 23 coinsurance, deductible, or other out-of-pocket expense 24 obligation imposed on a covered person by a policy, contract, 25 or plan providing for third-party payment or prepayment of 26 health or medical expenses. 27 e. “Covered person” means a policyholder, subscriber, or 28 other person participating in a policy, contract, or plan that 29 provides for third-party payment or prepayment of health or 30 medical expenses. 31 f. “Diagnostic breast cancer examination” means an 32 examination of an abnormality, deemed medically necessary by a 33 covered person’s health care professional, for the detection 34 of breast cancer. The examination may be conducted using a 35 -1- LSB 6229XS (1) 88 ko/rn 1/ 6

S.F. 2216 diagnostic mammogram, breast magnetic resonance imaging, or a 1 breast ultrasound. 2 g. “Diagnostic mammogram” means a detailed examination of a 3 breast abnormality using X ray. 4 h. “Health care professional” means the same as defined in 5 section 514J.102. 6 i. “Health care services” means services for the diagnosis, 7 prevention, treatment, cure, or relief of a health condition, 8 illness, injury, or disease. 9 j. “Screening mammogram” means an examination of a breast 10 using a low-dose x-ray system to see inside the breast, and 11 that aids in the early detection and diagnosis of breast 12 cancer. 13 2. Notwithstanding the uniformity of treatment requirements 14 of section 514C.6, a policy, contract, or plan providing 15 for third-party payment or prepayment of health or medical 16 expenses shall provide coverage for diagnostic breast cancer 17 examinations. The policy, contract, or plan shall not require 18 cost-sharing greater than the cost-sharing that the policy, 19 contract, or plan requires for a screening mammogram. 20 3. a. This section shall apply to the following classes of 21 third-party payment provider contracts, policies, or plans: 22 (1) Individual or group accident and sickness insurance 23 providing coverage on an expense-incurred basis. 24 (2) An individual or group hospital or medical service 25 contract issued pursuant to chapter 509, 514, or 514A. 26 (3) An individual or group health maintenance organization 27 contract regulated under chapter 514B. 28 (4) A plan established for public employees pursuant to 29 chapter 509A. 30 b. This section shall not apply to accident-only, specified 31 disease, short-term hospital or medical, hospital confinement 32 indemnity, credit, dental, vision, Medicare supplement, 33 long-term care, basic hospital and medical-surgical expense 34 coverage as defined by the commissioner of insurance, 35 -2- LSB 6229XS (1) 88 ko/rn 2/ 6

S.F. 2216 disability income insurance coverage, coverage issued as a 1 supplement to liability insurance, workers’ compensation or 2 similar insurance, or automobile medical payment insurance. 3 4. The commissioner of insurance shall adopt rules pursuant 4 to chapter 17A to administer this section. 5 Sec. 2. NEW SECTION . 514C.24A Prescription drugs —— stage 6 IV cancer. 7 1. As used in this section, unless the context otherwise 8 requires: 9 a. “Associated conditions” means symptoms or side effects 10 associated with stage IV cancer, or with the health care 11 services for stage IV cancer provided by a covered person’s 12 health care professional, that in the opinion of the health 13 care professional further jeopardize the covered person’s 14 health if left untreated. 15 b. “Covered person” means a policyholder, subscriber, or 16 other person participating in a policy, contract, or plan that 17 provides for third-party payment or prepayment of health or 18 medical expenses that provides coverage for prescription drugs. 19 c. “Health care professional” means the same as defined in 20 section 514J.102. 21 d. “Health care services” means services for the diagnosis, 22 prevention, treatment, cure, or relief of a health condition, 23 illness, injury, or disease. 24 e. “Prescription cancer drug” means a prescription drug that 25 is used for the treatment of stage IV cancer. 26 f. “Prescription drug” means a prescription drug that has 27 been prescribed as medically necessary by a covered person’s 28 health care professional. 29 g. “Stage IV cancer” means cancer that has spread from the 30 primary or original site of the cancer to other parts of the 31 body. Stage IV cancer may also be referred to as advanced 32 cancer or metastatic cancer. 33 h. “Step therapy protocol” means the same as defined in 34 section 514F.7. 35 -3- LSB 6229XS (1) 88 ko/rn 3/ 6

S.F. 2216 2. a. Notwithstanding the uniformity of treatment 1 requirements of section 514C.6, a policy, contract, or plan 2 providing for third-party payment or prepayment of health or 3 medical expenses that provides coverage for prescription drugs 4 shall provide coverage for prescription cancer drugs. 5 b. Notwithstanding section 514F.7, the policy, contract, or 6 plan shall provide coverage, without imposing a step therapy 7 protocol, for a prescription cancer drug that meets all of the 8 following requirements: 9 (1) The use of the prescription cancer drug is in accordance 10 with the medical standards of care for stage IV cancer. 11 (2) The use of the prescription cancer drug for stage 12 IV cancer is supported by peer-reviewed, evidence-based 13 literature. 14 (3) The prescription cancer drug has been approved by the 15 United States food and drug administration. 16 3. a. This section shall apply to the following classes of 17 third-party payment provider contracts, policies, or plans: 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) A plan established for public employees pursuant to 25 chapter 509A. 26 b. This section shall not apply to accident-only, specified 27 disease, short-term hospital or medical, hospital confinement 28 indemnity, credit, dental, vision, Medicare supplement, 29 long-term care, basic hospital and medical-surgical expense 30 coverage as defined by the commissioner of insurance, 31 disability income insurance coverage, coverage issued as a 32 supplement to liability insurance, workers’ compensation or 33 similar insurance, or automobile medical payment insurance. 34 4. The commissioner of insurance shall adopt rules pursuant 35 -4- LSB 6229XS (1) 88 ko/rn 4/ 6

S.F. 2216 to chapter 17A to administer this section. 1 Sec. 3. APPLICABILITY. This Act applies to third-party 2 payment provider contracts, policies, or plans delivered, 3 issued for delivery, continued, or renewed in this state on or 4 after January 1, 2021. 5 EXPLANATION 6 The inclusion of this explanation does not constitute agreement with 7 the explanation’s substance by the members of the general assembly. 8 This bill relates to insurance coverage for diagnostic 9 breast cancer examinations and prescription drugs used in the 10 treatment of stage IV cancer. 11 The bill requires a policy, contract, or plan providing for 12 third-party payment or prepayment of health or medical expenses 13 to provide coverage for diagnostic breast cancer examinations. 14 “Diagnostic breast cancer examination” is defined in the bill 15 as an examination of an abnormality, deemed medically necessary 16 by a covered person’s health care professional, for the 17 detection of breast cancer. The examination may be conducted 18 using a diagnostic mammogram, breast magnetic resonance 19 imaging, or breast ultrasound. “Abnormality”, “diagnostic 20 mammogram”, “breast magnetic resonance imaging”, and “breast 21 ultrasound” are also defined in the bill. 22 The policy, contract, or plan cannot require cost-sharing 23 greater than the cost-sharing that the policy, contract, or 24 plan requires for a screening mammogram. “Cost-sharing” and 25 “screening mammogram” are defined in the bill. 26 The bill also requires policies, contracts, or plans 27 providing for third-party payment or prepayment of health 28 or medical expenses that provide coverage for prescription 29 drugs to provide coverage for prescription cancer drugs. 30 “Prescription cancer drug” is defined in the bill as a 31 prescription drug that is used to treat stage IV cancer. 32 “Stage IV cancer” is also defined in the bill. 33 The policy, contract, or plan is required to provide 34 coverage, without imposing a step therapy protocol, for a 35 -5- LSB 6229XS (1) 88 ko/rn 5/ 6

S.F. 2216 prescription cancer drug that has been approved by the United 1 States food and drug administration, the use of which is 2 in accordance with medical standards of care for stage IV 3 cancer, and the use of which is supported by peer-reviewed, 4 evidence-based literature. “Step therapy protocol” is defined 5 in the bill as a protocol or program that establishes a 6 specific sequence in which prescription drugs for a specified 7 medical condition and medically appropriate for a particular 8 covered person are covered under a pharmacy or medical benefit 9 by a health carrier, a health benefit plan, or a utilization 10 review organization, including self-administered drugs and 11 drugs administered by a health care professional. 12 The bill applies to third-party payment providers enumerated 13 in the bill. The bill specifies the types of specialized 14 health-related insurance which are not subject to the coverage 15 requirements of the bill. 16 The commissioner of insurance is required to adopt rules to 17 administer the requirements of the bill. 18 The bill applies to third-party payment provider contracts, 19 policies, or plans delivered, issued for delivery, continued, 20 or renewed in this state on or after January 1, 2021. 21 -6- LSB 6229XS (1) 88 ko/rn 6/ 6