Text: HF02191 Text: HF02193 Text: HF02100 - HF02199 Text: HF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN
1 1 Section 1. NEW SECTION. 513A.9 PHARMACEUTICAL CONTRACT
1 2 DISCLOSURES.
1 3 1. A third-party payor providing payment or prepayment for
1 4 prescription drugs under a policy or contract of individual or
1 5 group accident and sickness insurance shall include in a
1 6 contract or evidence of coverage form provided to the
1 7 individual or group a disclosure of any drug formularies or
1 8 other similar arrangements with pharmaceutical companies,
1 9 including any rebate, discount, or other incentive received by
1 10 the third-party payor under such formularies or arrangements.
1 11 2. For purposes of this section unless the context
1 12 otherwise requires, a third-party payor means:
1 13 a. An accident and sickness insurer, subject to chapter
1 14 509 or 514A.
1 15 b. A nonprofit health service corporation, subject to
1 16 chapter 514.
1 17 c. A health maintenance organization, subject to chapter
1 18 514B.
1 19 d. A preferred provider organization regulated under
1 20 chapter 514F, or other similar organization.
1 21 e. Any other entity engaged in the business of insurance,
1 22 risk transfer, or risk retention, which is subject to the
1 23 jurisdiction of the commissioner.
1 24 f. An organized delivery system regulated under rules
1 25 adopted by the director of public health.
1 26 EXPLANATION
1 27 This bill provides that a third-party payor of health
1 28 benefits is to include in a contract or evidence of coverage
1 29 form provided to an individual or group receiving such
1 30 benefits a disclosure of any drug formularies or other similar
1 31 arrangements with pharmaceutical companies, including any
1 32 rebate, discount, or other incentive received by the third-
1 33 party payor under such formularies or arrangements. The bill
1 34 applies to an accident and sickness insurer subject to Code
1 35 chapter 509 or 514A; a nonprofit health service corporation,
2 1 subject to Code chapter 514; a health maintenance
2 2 organization, subject to Code chapter 514B; a preferred
2 3 provider organization regulated under Code chapter 514F, or
2 4 other similar organization; any other entity engaged in the
2 5 business of insurance, risk transfer, or risk retention, which
2 6 is subject to the jurisdiction of the commissioner; and an
2 7 organized delivery system regulated under rules adopted by the
2 8 director of public health.
2 9 LSB 3522HH 77
2 10 mj/jw/5.1
Text: HF02191 Text: HF02193 Text: HF02100 - HF02199 Text: HF Index Bills and Amendments: General Index Bill History: General Index
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