Senate File 561 H-1331 Amend Senate File 561, as amended, passed, and reprinted by 1 the Senate, as follows: 2 1. Page 77, after line 35 by inserting: 3 < DIVISION ___ 4 PRESCRIPTION INSULIN DRUGS —— COVERAGE 5 Sec. ___. NEW SECTION . 514C.18A Prescription insulin drugs 6 —— coverage. 7 1. As used in this section, unless the context otherwise 8 requires: 9 a. “Cost-sharing” means any coverage limit, copayment, 10 coinsurance, deductible, or other out-of-pocket expense 11 obligation imposed on a covered person by a policy, contract, 12 or plan providing for third-party payment or prepayment of 13 health or medical expenses. 14 b. “Covered person” means a policyholder, subscriber, or 15 other person participating in a policy, contract, or plan that 16 provides for third-party payment or prepayment of health or 17 medical expenses. 18 c. “Health care professional” means the same as defined in 19 section 514J.102. 20 d. “Prescription insulin drug” means a prescription drug 21 that contains insulin, is used to treat diabetes, that has been 22 prescribed as medically necessary by a covered person’s health 23 care professional, and is a benefit covered by the covered 24 person’s policy, contract, or plan. 25 2. Notwithstanding the uniformity of treatment requirements 26 of section 514C.6, a policy, contract, or plan providing for 27 third-party payment or prepayment of health or medical expenses 28 that provides coverage for prescription drugs shall cap the 29 total amount of cost-sharing that a covered person is required 30 to pay per prescription filled to an amount not to exceed 31 twenty-five dollars for up to a thirty-one-day supply of at 32 least one type of each of the following: 33 a. Rapid-acting prescription insulin drugs. 34 b. Short-acting prescription insulin drugs. 35 -1- SF 561.2063 (2) 90 pf/rn 1/ 3 #1.

c. Intermediate-acting prescription insulin drugs. 1 d. Long-acting prescription insulin drugs. 2 3. Nothing in this section shall be construed to prohibit 3 a policy, contract, or plan providing for third-party payment 4 or prepayment of health or medical expenses from reducing a 5 covered person’s cost-sharing obligation by an amount greater 6 than the amount specified pursuant to subsection 2. 7 4. a. This section shall apply to the following classes 8 of third-party payment provider contracts, policies, or plans 9 delivered, issued for delivery, continued, or renewed in this 10 state on or after January 1, 2024: 11 (1) Individual or group accident and sickness insurance 12 providing coverage on an expense-incurred basis. 13 (2) An individual or group hospital or medical service 14 contract issued pursuant to chapter 509, 514, or 514A. 15 (3) An individual or group health maintenance organization 16 contract regulated under chapter 514B. 17 (4) A plan established for public employees pursuant to 18 chapter 509A. 19 b. This section shall not apply to accident-only, specified 20 disease, short-term hospital or medical, hospital confinement 21 indemnity, credit, dental, vision, Medicare supplement, 22 long-term care, basic hospital and medical-surgical expense 23 coverage as defined by the commissioner of insurance, 24 disability income insurance coverage, coverage issued as a 25 supplement to liability insurance, workers’ compensation or 26 similar insurance, or automobile medical payment insurance. 27 5. The commissioner of insurance may adopt rules pursuant to 28 chapter 17A to administer this section. > 29 2. Title page, line 10, after < institutions, > by inserting 30 < prescription insulin drug coverage, > 31 3. By renumbering as necessary. 32 -2- SF 561.2063 (2) 90 pf/rn 2/ 3 #2.