House File 727 H-1211 Amend House File 727 as follows: 1 1. By striking everything after the enacting clause and 2 inserting: 3 < Section 1. Section 155A.3, Code 2019, is amended by adding 4 the following new subsections: 5 NEW SUBSECTION . 10A. “Department” means the department of 6 public health. 7 NEW SUBSECTION . 44A. “Self-administered hormonal 8 contraceptive” means a self-administered hormonal contraceptive 9 that is approved by the United States food and drug 10 administration to prevent pregnancy. “Self-administered 11 hormonal contraceptive” includes an oral hormonal contraceptive, 12 a hormonal vaginal ring, and a hormonal contraceptive patch, 13 but does not include any drug intended to induce an abortion as 14 defined in section 146.1. 15 NEW SUBSECTION . 44B. “Standing order” means a preauthorized 16 medication order with specific instructions from the medical 17 director of the department to dispense a medication under 18 clearly defined circumstances. 19 Sec. 2. NEW SECTION . 155A.47 Pharmacist dispensing of 20 self-administered hormonal contraceptives —— standing order —— 21 requirements —— limitations of liability. 22 1. a. Notwithstanding any provision of law to the contrary, 23 a pharmacist may dispense a self-administered hormonal 24 contraceptive to a patient, who is at least eighteen years of 25 age, pursuant to a standing order established by the medical 26 director of the department in accordance with this section. 27 b. In dispensing a self-administered hormonal contraceptive 28 to a patient under this section, a pharmacist shall comply with 29 the following: 30 (1) For an initial dispensing of a self-administered 31 hormonal contraceptive, the pharmacist may dispense only up 32 to a three-month supply at one time of the self-administered 33 hormonal contraceptive. 34 (2) For any subsequent dispensing of the same 35 -1- HF727.1802 (2) 88 (amending this HF 727 to CONFORM to SF 513) pf/rh 1/ 9 #1.

self-administered hormonal contraceptive, the pharmacist 1 may dispense up to a twelve-month supply at one time of the 2 self-administered hormonal contraceptive. 3 2. A pharmacist who dispenses a self-administered hormonal 4 contraceptive in accordance with this section shall not 5 require any other prescription drug order authorized by a 6 practitioner prior to dispensing the self-administered hormonal 7 contraceptive to a patient. 8 3. The medical director of the department may establish a 9 standing order authorizing the dispensing of self-administered 10 hormonal contraceptives by a pharmacist who does all of the 11 following: 12 a. Complies with the standing order established pursuant to 13 this section. 14 b. Retains a record of each patient to whom a 15 self-administered hormonal contraceptive is dispensed under 16 this section and submits the record to the department. 17 4. The standing order shall require a pharmacist who 18 dispenses self-administered hormonal contraceptives under this 19 section to do all of the following: 20 a. Complete a standardized training program and continuing 21 education requirements approved by the board in consultation 22 with the department that are related to prescribing 23 self-administered hormonal contraceptives and include education 24 regarding all contraceptive methods approved by the United 25 States food and drug administration. 26 b. Obtain a completed self-screening risk assessment, 27 approved by the department in collaboration with the board and 28 the board of medicine, from each patient, verify the identity 29 and age of each patient, and perform a blood pressure screening 30 on each patient, prior to dispensing the self-administered 31 hormonal contraceptive to the patient. 32 c. Provide the patient with all of the following: 33 (1) Written information regarding all of the following: 34 (a) The importance of completing an appointment with the 35 -2- HF727.1802 (2) 88 (amending this HF 727 to CONFORM to SF 513) pf/rh 2/ 9

patient’s primary care or women’s health care practitioner 1 to obtain preventative care, including but not limited to 2 recommended tests and screenings. 3 (b) The effectiveness and availability of long-acting 4 reversible contraceptives as an alternative to 5 self-administered hormonal contraceptives. 6 (2) A copy of the record of the pharmacist’s encounter with 7 the patient that includes all of the following: 8 (a) The patient’s completed self-screening risk assessment. 9 (b) A description of the contraceptive dispensed, or the 10 basis for not dispensing a contraceptive. 11 (3) Patient counseling regarding all of the following: 12 (a) The appropriate administration and storage of the 13 self-administered hormonal contraceptive. 14 (b) Potential side effects and risks of the 15 self-administered hormonal contraceptive. 16 (c) The need for backup contraception. 17 (d) When to seek emergency medical attention. 18 (e) The risk of contracting a sexually transmitted 19 infection or disease, and ways to reduce such a risk. 20 5. The standing order established pursuant to this section 21 shall prohibit a pharmacist who dispenses a self-administered 22 hormonal contraceptive under this section from doing any of the 23 following: 24 a. Requiring a patient to schedule an appointment with 25 the pharmacist for the prescribing or dispensing of a 26 self-administered hormonal contraceptive. 27 b. Dispensing self-administered hormonal contraceptives to 28 a patient for more than twenty-four months after the date a 29 self-administered hormonal contraceptive is initially dispensed 30 to the patient without the patient’s attestation that the 31 patient has consulted with a primary care or women’s health 32 care practitioner during the preceding twenty-four months. 33 c. Dispensing a self-administered hormonal contraceptive to 34 a patient if the results of the self-screening risk assessment 35 -3- HF727.1802 (2) 88 (amending this HF 727 to CONFORM to SF 513) pf/rh 3/ 9

completed by a patient pursuant to subsection 4, paragraph 1 “b” , indicate it is unsafe for the pharmacist to dispense the 2 self-administered hormonal contraceptive to the patient, in 3 which case the pharmacist shall refer the patient to a primary 4 care or women’s health care practitioner. 5 6. A pharmacist who dispenses a self-administered hormonal 6 contraceptive and the medical director of the department who 7 establishes a standing order in compliance with this section 8 shall be immune from criminal and civil liability arising from 9 any damages caused by the dispensing, administering, or use of 10 a self-administered hormonal contraceptive or the establishment 11 of the standing order, provided that the pharmacist acts 12 reasonably and in good faith. The medical director of the 13 department shall be considered to be acting within the scope 14 of the medical director’s office and employment for purposes 15 of chapter 669 in the establishment of a standing order in 16 compliance with this section. 17 7. The department, in collaboration with the board and 18 the board of medicine, and in consideration of the guidelines 19 established by the American congress of obstetricians and 20 gynecologists, shall adopt rules pursuant to chapter 17A to 21 administer this chapter. 22 Sec. 3. Section 514C.19, Code 2019, is amended to read as 23 follows: 24 514C.19 Prescription contraceptive coverage. 25 1. Notwithstanding the uniformity of treatment requirements 26 of section 514C.6 , a group policy , or contract , or plan 27 providing for third-party payment or prepayment of health or 28 medical expenses shall not do either of the following comply 29 as follows : 30 a. Exclude Such policy, contract, or plan shall not 31 exclude or restrict benefits for prescription contraceptive 32 drugs or prescription contraceptive devices which prevent 33 conception and which are approved by the United States 34 food and drug administration, or generic equivalents 35 -4- HF727.1802 (2) 88 (amending this HF 727 to CONFORM to SF 513) pf/rh 4/ 9

approved as substitutable by the United States food and drug 1 administration, if such policy , or contract , or plan provides 2 benefits for other outpatient prescription drugs or devices. 3 However, such policy, contract, or plan shall specifically 4 provide for payment, including reimbursement for pharmacist 5 consultations, for a self-administered hormonal contraceptive, 6 as prescribed by a practitioner as defined in section 7 155A.3, or as prescribed by standing order and dispensed by a 8 pharmacist pursuant to section 155A.47, including payment for 9 up to an initial three-month supply of the self-administered 10 hormonal contraceptive dispensed at one time and for up to a 11 twelve-month supply of the same self-administered hormonal 12 contraceptive subsequently dispensed at one time. 13 b. Exclude Such policy, contract, or plan shall not exclude 14 or restrict benefits for outpatient contraceptive services 15 which are provided for the purpose of preventing conception if 16 such policy , or contract , or plan provides benefits for other 17 outpatient services provided by a health care professional. 18 2. A person who provides a group policy , or contract , or 19 plan providing for third-party payment or prepayment of health 20 or medical expenses which is subject to subsection 1 shall not 21 do any of the following: 22 a. Deny to an individual eligibility, or continued 23 eligibility, to enroll in or to renew coverage under the terms 24 of the policy , or contract , or plan because of the individual’s 25 use or potential use of such prescription contraceptive drugs 26 or devices, or use or potential use of outpatient contraceptive 27 services. 28 b. Provide a monetary payment or rebate to a covered 29 individual to encourage such individual to accept less than the 30 minimum benefits provided for under subsection 1 . 31 c. Penalize or otherwise reduce or limit the reimbursement 32 of a health care professional because such professional 33 prescribes contraceptive drugs or devices, or provides 34 contraceptive services. 35 -5- HF727.1802 (2) 88 (amending this HF 727 to CONFORM to SF 513) pf/rh 5/ 9

d. Provide incentives, monetary or otherwise, to a health 1 care professional to induce such professional to withhold 2 from a covered individual contraceptive drugs or devices, or 3 contraceptive services. 4 3. This section shall not be construed to prevent a 5 third-party payor from including deductibles, coinsurance, or 6 copayments under the policy , or contract, or plan as follows: 7 a. A deductible, coinsurance, or copayment for benefits 8 for prescription contraceptive drugs shall not be greater than 9 such deductible, coinsurance, or copayment for any outpatient 10 prescription drug for which coverage under the policy , or 11 contract , or plan is provided. 12 b. A deductible, coinsurance, or copayment for benefits for 13 prescription contraceptive devices shall not be greater than 14 such deductible, coinsurance, or copayment for any outpatient 15 prescription device for which coverage under the policy , or 16 contract , or plan is provided. 17 c. A deductible, coinsurance, or copayment for benefits for 18 outpatient contraceptive services shall not be greater than 19 such deductible, coinsurance, or copayment for any outpatient 20 health care services for which coverage under the policy , or 21 contract , or plan is provided. 22 4. This section shall not be construed to require a 23 third-party payor under a policy , or contract , or plan 24 to provide benefits for experimental or investigational 25 contraceptive drugs or devices, or experimental or 26 investigational contraceptive services, except to the extent 27 that such policy , or contract , or plan provides coverage for 28 other experimental or investigational outpatient prescription 29 drugs or devices, or experimental or investigational outpatient 30 health care services. 31 5. This section shall not be construed to limit or otherwise 32 discourage the use of generic equivalent drugs approved by the 33 United States food and drug administration, whenever available 34 and appropriate. This section , when a brand name drug is 35 -6- HF727.1802 (2) 88 (amending this HF 727 to CONFORM to SF 513) pf/rh 6/ 9

requested by a covered individual and a suitable generic 1 equivalent is available and appropriate, shall not be construed 2 to prohibit a third-party payor from requiring the covered 3 individual to pay a deductible, coinsurance, or copayment 4 consistent with subsection 3 , in addition to the difference of 5 the cost of the brand name drug less the maximum covered amount 6 for a generic equivalent. 7 6. A person who provides an individual policy , or contract , 8 or plan providing for third-party payment or prepayment of 9 health or medical expenses shall make available a coverage 10 provision that satisfies the requirements in subsections 11 1 through 5 in the same manner as such requirements are 12 applicable to a group policy , or contract , or plan under those 13 subsections. The policy , or contract , or plan shall provide 14 that the individual policyholder may reject the coverage 15 provision at the option of the policyholder. 16 7. a. This section applies to the following classes of 17 third-party payment provider contracts , or policies , or plan 18 delivered, issued for delivery, continued, or renewed in this 19 state on or after July 1, 2000 January 1, 2020 : 20 (1) Individual or group accident and sickness insurance 21 providing coverage on an expense-incurred basis. 22 (2) An individual or group hospital or medical service 23 contract issued pursuant to chapter 509 , 514 , or 514A . 24 (3) An individual or group health maintenance organization 25 contract regulated under chapter 514B . 26 (4) Any other entity engaged in the business of insurance, 27 risk transfer, or risk retention, which is subject to the 28 jurisdiction of the commissioner. 29 (5) A plan established pursuant to chapter 509A for public 30 employees. 31 b. This section shall not apply to accident-only, 32 specified disease, short-term hospital or medical, hospital 33 confinement indemnity, credit, dental, vision, Medicare 34 supplement, long-term care, basic hospital and medical-surgical 35 -7- HF727.1802 (2) 88 (amending this HF 727 to CONFORM to SF 513) pf/rh 7/ 9

expense coverage as defined by the commissioner, disability 1 income insurance coverage, coverage issued as a supplement 2 to liability insurance, workers’ compensation or similar 3 insurance, or automobile medical payment insurance. 4 8. This section shall not be construed to require a 5 third-party payor to provide payment to a practitioner for the 6 dispensing of a self-administered hormonal contraceptive to 7 replace a self-administered hormonal contraceptive that has 8 been dispensed to a covered person and that has been misplaced, 9 stolen, or destroyed. This section shall not be construed to 10 require a third-party payor to replace covered prescriptions 11 that are misplaced, stolen, or destroyed. 12 9. For the purposes of this section: 13 a. “Self-administered hormonal contraceptive” means a 14 self-administered hormonal contraceptive that is approved 15 by the United Sates food and drug administration to prevent 16 pregnancy. “Self-administered hormonal contraceptive” includes 17 an oral hormonal contraceptive, a hormonal vaginal ring, and 18 a hormonal contraceptive patch, but does not include any drug 19 intended to induce an abortion as defined in section 146.1. 20 b. “Standing order” means a preauthorized medication order 21 with specific instructions from the medical director of the 22 department of public health to dispense a medication under 23 clearly defined circumstances. 24 Sec. 4. MEDICAID COVERAGE —— SELF-ADMINISTERED HORMONAL 25 CONTRACEPTIVES. The department of human services shall, 26 contractually and by administrative rules adopted pursuant 27 to chapter 17A, require under Medicaid fee-for-service 28 and Medicaid managed care administration, coverage for 29 a self-administered hormonal contraceptive as prescribed 30 by a practitioner as defined in section 155A.3, or as 31 prescribed by standing order and dispensed by a pharmacist 32 pursuant to section 155A.47, including payment for up to 33 an initial three-month supply of the self-administered 34 hormonal contraceptive dispensed at one time and for up to a 35 -8- HF727.1802 (2) 88 (amending this HF 727 to CONFORM to SF 513) pf/rh 8/ 9