Text: HF00309 Text: HF00311 Text: HF00300 - HF00399 Text: HF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Section 1. NEW SECTION. 514C.5A PRESCRIPTION DRUGS
1 2 BENEFITS – REIMBURSEMENT.
1 3 1. a. Except as provided in paragraph "b", a policy or
1 4 contract providing for third-party payment or prepayment for
1 5 pharmaceutical services shall provide for the direct
1 6 reimbursement of a licensed pharmacist or licensed pharmacy
1 7 providing covered pharmaceutical services.
1 8 b. A policy or contract providing for third-party payment
1 9 or prepayment for pharmaceutical services shall provide for
1 10 the direct reimbursement of the department of human services
1 11 for covered pharmaceutical services provided to persons
1 12 eligible to receive medical assistance under chapter 249A.
1 13 2. This section applies to the following classes of third-
1 14 party payor contracts or policies delivered, issued for
1 15 delivery, continued, or renewed in this state on or after July
1 16 1, 1997:
1 17 a. Individual or group accident and sickness insurance
1 18 providing coverage on an expense-incurred basis.
1 19 b. An individual or group hospital or medical service
1 20 contract issued pursuant to chapter 509, 514, or 514A.
1 21 c. An individual or group health maintenance organization
1 22 contract regulated under chapter 514B.
1 23 d. An individual or group Medicare supplemental policy,
1 24 unless coverage pursuant to such policy is preempted by
1 25 federal law.
1 26 e. An organized delivery system licensed by the director
1 27 of public health.
1 28 f. Any other entity engaged in the business of insurance,
1 29 risk transfer, or risk retention, which is subject to the
1 30 jurisdiction of the commissioner.
1 31 EXPLANATION
1 32 This bill provides that an individual or group policy or
1 33 contract providing for third-party payment or prepayment for
1 34 pharmaceutical services shall provide for the direct
1 35 reimbursement of a licensed pharmacist or licensed pharmacy
2 1 providing covered pharmaceutical services.
2 2 The bill also provides that such third-party payor provide
2 3 for the direct reimbursement of the department of human
2 4 services for covered pharmaceutical services provided to
2 5 persons eligible to receive medical assistance under chapter
2 6 249A.
2 7 The bill applies to the third-party payor contracts or
2 8 policies delivered, issued for delivery, continued, or renewed
2 9 in this state on or after July 1, 1997, including an
2 10 individual or group hospital or medical service contract
2 11 issued pursuant to chapter 509, 514, or 514A; an individual or
2 12 group health maintenance organization contract regulated under
2 13 chapter 514B; an individual or group Medicare supplemental
2 14 policy, unless coverage pursuant to such policy is preempted
2 15 by federal law; an organized delivery system licensed by the
2 16 director of public health; and any other entity engaged in the
2 17 business of insurance, risk transfer, or risk retention, which
2 18 is subject to the jurisdiction of the commissioner.
2 19 LSB 2199HH 77
2 20 mj/jj/8
Text: HF00309 Text: HF00311 Text: HF00300 - HF00399 Text: HF Index Bills and Amendments: General Index Bill History: General Index
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