S-3141

   Amend House File 700, as passed by the House, as follows:
   1.  By striking everything after the enacting clause and inserting: 
   <Section 1.  Section 155A.29, Code 2019, is amended to read as follows:
   155A.29  Prescription refills.
   1.  Except as specified in subsection 2 or 3, a prescription for any prescription drug or device which is not a controlled substance shall not be filled or refilled more than eighteen months after the date on which the prescription was issued and a prescription which is authorized to be refilled shall not be refilled more than twelve times.
   2.  A pharmacist may exercise professional judgment by refilling a prescription without prescriber authorization if all of the following are true:
   a.  The pharmacist is unable to contact the prescriber after reasonable effort efforts.
   b.  Failure to refill the prescription might result in an interruption of therapeutic regimen or create patient suffering.
   c.  The pharmacist informs the patient or the patient’s representative at the time of dispensing, and the practitioner at the earliest convenience that prescriber reauthorization is required.
   3.  d.  Prescriptions may be refilled once pursuant to subsection 2 for a period of time reasonably necessary for the pharmacist to secure prescriber authorization.
   3.  a.  In addition to the authorization for a pharmacist to refill a prescription without prescriber authorization pursuant to subsection 2, a pharmacist may exercise professional judgment and refill a prescription for and dispense insulin without prescriber authorization if all of the following conditions are met:
   (1)  The pharmacy has a record of the patient’s expired prescription.
   (2)  The pharmacist is unable to contact the prescriber after reasonable efforts.
   (3)  The insulin is essential to the health of the patient and the patient will be harmed if the insulin is not dispensed.
   b.  The pharmacist may dispense insulin pursuant to this subsection in an amount not to exceed a thirty-day supply and only once in a twelve-month period.
   4.  An authorization to refill a prescription drug order shall be transmitted to a pharmacy by a prescriber or the prescriber’s authorized agent pursuant to section 155A.27, except that prescription drug orders for controlled substances shall be transmitted pursuant to section 124.308, and, if not transmitted directly by the practitioner, shall also include the name and title of the practitioner’s agent completing the transmission.
   Sec. 2.  NEW SECTION.  514C.18A  Insulin coverage.
   1.  Notwithstanding the uniformity of treatment requirements of section 514C.6, a policy or contract providing for third-party payment or prepayment of insulin when prescribed by a practitioner as defined in section 155A.3, shall provide coverage for insulin dispensed without authorization pursuant to section 155A.29, subsection 3, for an amount not to exceed a thirty-day supply and only once in a twelve-month period.
   2.  a.  This section applies to the following classes of third-party payment provider contracts or policies delivered, issued for delivery, continued, or renewed in this state on or after July 1, 2019:
   (1)  Individual or group accident and sickness insurance providing coverage on an expense-incurred basis.
   (2)  An individual or group hospital or medical service contract issued pursuant to chapter 509, 514, or 514A.
   (3)  An individual or group health maintenance organization contract regulated under chapter 514B.
   (4)  Any other entity engaged in the business of insurance, risk transfer, or risk retention, which is subject to the jurisdiction of the commissioner.
   (5)  A plan established pursuant to chapter 509A for public employees.
   b.  This section shall not apply to accident-only, specified disease, short-term hospital or medical, hospital confinement indemnity, credit, dental, vision, Medicare supplement, long-term care, basic hospital and medical-surgical expense coverage as defined by the commissioner, disability income insurance coverage, coverage issued as a supplement to liability insurance, workers’ compensation or similar insurance, or automobile medical payment insurance.>
   2.  Title page, by striking lines 1 and 2 and inserting <An Act relating to the dispensing of insulin in emergency situations, and providing for insurance coverage.>

______________________________
THOMAS A. GREENE