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Senate File 413 - IntroducedA Bill ForAn Act 1relating to insurance coverage for prescription drugs
2used to treat substance use disorders.
3BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 Section 1. NEW SECTION. 514C.36 Prescription drugs —
2substance use disorders.
31. As used in this section, unless the context otherwise
4requires:
5a. “Covered person” means a policyholder, subscriber, or
6other person participating in a policy, contract, or plan that
7provides for third-party payment or prepayment of health or
8medical expenses that provides coverage for prescription drugs.
9b. “Health care professional” means the same as defined in
10section 514J.102.
11c. “Health carrier” means the same as defined in section
12514J.102.
13d. “Prescription drug” means a prescription medication,
14including an injectable medication, that has been prescribed
15as medically necessary by a covered person’s health care
16professional.
172. a. Notwithstanding the uniformity of treatment
18requirements of section 514C.6, a policy, contract, or plan
19providing for third-party payment or prepayment of health or
20medical expenses that provides coverage for prescription drugs
21shall provide coverage for all prescription drugs approved
22by the United States food and drug administration to treat
23substance use disorders.
24b. Coverage required under this section shall not be less
25favorable than coverage a health carrier offers for general
26physical illness.
27c. Cost-sharing imposed for coverage required under this
28section shall not be less favorable than cost-sharing a health
29carrier imposes for general physical illness.
303. a. This section applies to the following classes of
31third-party payment provider contracts, policies, or plans
32delivered, issued for delivery, continued, or renewed in this
33state on or after January 1, 2024:
34(1) Individual or group accident and sickness insurance
35providing coverage on an expense-incurred basis.
-1- 1(2) An individual or group hospital or medical service
2contract issued pursuant to chapter 509, 514, or 514A.
3(3) An individual or group health maintenance organization
4contract regulated under chapter 514B.
5(4) A plan established for public employees pursuant to
6chapter 509A.
7b. This section shall not apply to accident-only, specified
8disease, short-term hospital or medical, hospital confinement
9indemnity, credit, dental, vision, Medicare supplement,
10long-term care, basic hospital and medical-surgical expense
11coverage as defined by the commissioner of insurance,
12disability income insurance coverage, coverage issued as a
13supplement to liability insurance, workers’ compensation or
14similar insurance, or automobile medical payment insurance.
154. The commissioner of insurance may adopt rules pursuant to
16chapter 17A to administer this section.
17EXPLANATION
18The inclusion of this explanation does not constitute agreement with
19the explanation’s substance by the members of the general assembly.
20This bill relates to insurance coverage for prescription
21drugs used to treat substance use disorders.
22The bill requires policies, contracts, or plans providing
23for third-party payment or prepayment of health or medical
24expenses that provide coverage for prescription drugs to
25provide coverage for all prescription drugs approved by the
26United States food and drug administration to treat substance
27use disorders. “Prescription drug” is defined in the bill as
28prescription medication, including an injectable medication,
29that has been prescribed as medically necessary by a covered
30person’s health care professional.
31Coverage required under the bill shall not be less favorable
32than coverage a health carrier offers for general physical
33illness. Cost-sharing imposed for coverage required under the
34bill shall not be less favorable than cost-sharing a health
35carrier imposes for general physical illness.
-2- 1The bill applies to the third-party payment providers
2enumerated in the bill. The bill specifies the types of
3specialized health-related insurance which are not subject to
4the bill.
5The commissioner of insurance may adopt rules to administer
6the bill.
7The bill applies to third-party payment provider contracts,
8policies, or plans delivered, issued for delivery, continued,
9or renewed in this state on or after January 1, 2024.
-3-ko/rn
2used to treat substance use disorders.
3BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 Section 1. NEW SECTION. 514C.36 Prescription drugs —
2substance use disorders.
31. As used in this section, unless the context otherwise
4requires:
5a. “Covered person” means a policyholder, subscriber, or
6other person participating in a policy, contract, or plan that
7provides for third-party payment or prepayment of health or
8medical expenses that provides coverage for prescription drugs.
9b. “Health care professional” means the same as defined in
10section 514J.102.
11c. “Health carrier” means the same as defined in section
12514J.102.
13d. “Prescription drug” means a prescription medication,
14including an injectable medication, that has been prescribed
15as medically necessary by a covered person’s health care
16professional.
172. a. Notwithstanding the uniformity of treatment
18requirements of section 514C.6, a policy, contract, or plan
19providing for third-party payment or prepayment of health or
20medical expenses that provides coverage for prescription drugs
21shall provide coverage for all prescription drugs approved
22by the United States food and drug administration to treat
23substance use disorders.
24b. Coverage required under this section shall not be less
25favorable than coverage a health carrier offers for general
26physical illness.
27c. Cost-sharing imposed for coverage required under this
28section shall not be less favorable than cost-sharing a health
29carrier imposes for general physical illness.
303. a. This section applies to the following classes of
31third-party payment provider contracts, policies, or plans
32delivered, issued for delivery, continued, or renewed in this
33state on or after January 1, 2024:
34(1) Individual or group accident and sickness insurance
35providing coverage on an expense-incurred basis.
-1- 1(2) An individual or group hospital or medical service
2contract issued pursuant to chapter 509, 514, or 514A.
3(3) An individual or group health maintenance organization
4contract regulated under chapter 514B.
5(4) A plan established for public employees pursuant to
6chapter 509A.
7b. This section shall not apply to accident-only, specified
8disease, short-term hospital or medical, hospital confinement
9indemnity, credit, dental, vision, Medicare supplement,
10long-term care, basic hospital and medical-surgical expense
11coverage as defined by the commissioner of insurance,
12disability income insurance coverage, coverage issued as a
13supplement to liability insurance, workers’ compensation or
14similar insurance, or automobile medical payment insurance.
154. The commissioner of insurance may adopt rules pursuant to
16chapter 17A to administer this section.
17EXPLANATION
18The inclusion of this explanation does not constitute agreement with
19the explanation’s substance by the members of the general assembly.
20This bill relates to insurance coverage for prescription
21drugs used to treat substance use disorders.
22The bill requires policies, contracts, or plans providing
23for third-party payment or prepayment of health or medical
24expenses that provide coverage for prescription drugs to
25provide coverage for all prescription drugs approved by the
26United States food and drug administration to treat substance
27use disorders. “Prescription drug” is defined in the bill as
28prescription medication, including an injectable medication,
29that has been prescribed as medically necessary by a covered
30person’s health care professional.
31Coverage required under the bill shall not be less favorable
32than coverage a health carrier offers for general physical
33illness. Cost-sharing imposed for coverage required under the
34bill shall not be less favorable than cost-sharing a health
35carrier imposes for general physical illness.
-2- 1The bill applies to the third-party payment providers
2enumerated in the bill. The bill specifies the types of
3specialized health-related insurance which are not subject to
4the bill.
5The commissioner of insurance may adopt rules to administer
6the bill.
7The bill applies to third-party payment provider contracts,
8policies, or plans delivered, issued for delivery, continued,
9or renewed in this state on or after January 1, 2024.
-3-ko/rn