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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