H.F. 2329 Section 1. FINDINGS. The general assembly finds all of the 1 following: 2 1. The prevalence of adverse events and complications 3 relating to drug therapy is a significant public health 4 problem, resulting in serious health risks and reduced quality 5 of life for patients and additional cost to the health care 6 system. 7 2. The demonstrated success and cost-effectiveness of 8 medication therapy management in reducing preventable adverse 9 drug therapy events could be significantly expanded if 10 incorporated into all public and private health benefit plans. 11 3. The utilization of medication therapy management is 12 consistent with the concepts of collaborative team-based 13 delivery of care and the patient-centered medical home. 14 Sec. 2. NEW SECTION . 514C.26 Medication therapy management 15 coverage. 16 1. As used in this section: 17 a. “Commissioner” means the commissioner of insurance. 18 b. “Medication therapy management” means a systematic 19 process performed by a licensed pharmacist, designed to 20 optimize therapeutic outcomes through improved medication use 21 and reduced risk of adverse drug events, including all of the 22 following services: 23 (1) A medication therapy review of all medications, 24 vitamins, and herbal supplements currently being taken by an 25 eligible individual. 26 (2) A medication action plan, subject to the limitations 27 specified in this section, communicated to the individual and 28 the individual’s primary care physician or other appropriate 29 prescriber to address safety issues, inconsistencies, 30 duplicative therapy, omissions, and medication costs. The 31 medication action plan may include recommendations to the 32 prescriber for changes in drug therapy. 33 (3) Documentation and follow-up to ensure consistent levels 34 of pharmacy services and positive outcomes. 35 -1- LSB 5295HV (3) 83 pf/rj 1/ 4

H.F. 2329 2. Notwithstanding the uniformity of treatment requirements 1 of section 514C.6, a contract, policy, or plan providing 2 for third-party payment or prepayment for health or medical 3 expenses that include pharmaceutical benefits shall provide 4 coverage for medication therapy management in accordance 5 with rules adopted by the commissioner. The provisions of 6 this section shall apply to all of the following classes of 7 third-party payment provider contracts, policies, or plans 8 delivered, issued for delivery, continued, or renewed in this 9 state on or after July 1, 2010: 10 a. Individual or group accident and sickness insurance 11 providing coverage on an expense-incurred basis. 12 b. An individual or group hospital or medical service 13 contract issued pursuant to chapter 509, 514, or 514A. 14 c. An individual or group health maintenance organization 15 contract regulated under chapter 514B. 16 d. An individual or group Medicare supplemental policy, 17 unless coverage pursuant to such policy is preempted by federal 18 law. 19 e. A plan established pursuant to chapter 509A for public 20 employees. 21 3. This section shall not apply to accident-only, specified 22 disease, short-term hospital or medical, hospital confinement 23 indemnity, credit, dental, vision, long-term care, basic 24 hospital, and medical-surgical expense coverage as defined 25 by the commissioner, disability income insurance coverage, 26 coverage issued as a supplement to liability insurance, 27 workers’ compensation or similar insurance, or automobile 28 medical payment insurance. 29 4. The commissioner shall adopt rules pursuant to chapter 30 17A regarding coverage of benefits for medication therapy 31 management based on all of the following: 32 a. Medication therapy management shall be a covered benefit 33 for any of the following individuals: 34 (1) An individual who takes four or more prescription drugs 35 -2- LSB 5295HV (3) 83 pf/rj 2/ 4

H.F. 2329 to treat or prevent two or more chronic medical conditions. 1 (2) An individual who has a prescription drug therapy 2 problem as identified by the prescribing physician or other 3 appropriate prescriber, and is referred to a pharmacist for 4 medication therapy management. 5 (3) An individual who meets other criteria established by 6 the third-party payment provider contract, policy, or plan. 7 b. The fees for medication therapy management services 8 shall be separate from the reimbursement for prescription drug 9 product or dispensing services; shall be determined by each 10 third-party payment provider contract, policy, or plan; and 11 shall be reasonable based on the resources and time required 12 to provide the services. 13 c. A fee shall be established for physician reimbursement 14 for medication therapy management services provided which fee 15 shall be reasonable based on the resources and time required 16 to provide the services. 17 d. If any part of the medication therapy management 18 plan developed by a pharmacist incorporates services which 19 are outside the pharmacist’s independent scope of practice 20 including the initiation of therapy, modification of dosages, 21 therapeutic interchange, or changes in drug therapy, the 22 express authorization of the individual’s physician or other 23 appropriate prescriber is required. 24 Sec. 3. BOARD OF PHARMACY —— MEDICATION THERAPY MANAGEMENT 25 REGULATION. The board of pharmacy shall adopt rules pursuant 26 to chapter 17A for the regulation of medication therapy 27 management as defined in section 514C.26. The rules shall be 28 based on recommendations of an advisory committee comprised 29 of an equal number of physicians and pharmacists who practice 30 medication therapy management, as recommended by the Iowa 31 medical society, the Iowa osteopathic medicine association, and 32 the Iowa pharmacy association, outcomes pharmaceutical health 33 care, and the national association of chain drug stores. 34 EXPLANATION 1 -3- LSB 5295HV (3) 83 pf/rj 3/ 4

H.F. 2329 This bill relates to medication therapy management. The 2 bill defines “medication therapy management” and provides that 3 a contract, policy, or plan providing for third-party payment 4 or prepayment which includes coverage for health or medical 5 expenses that includes pharmaceutical benefits shall provide 6 coverage for medication therapy management in accordance 7 with rules adopted by the commissioner of insurance. The 8 bill specifies the classes of third-party payment provider 9 contracts, policies, or plans delivered, issued for delivery, 10 continued, or renewed in this state on or after July 1, 2010, 11 that must include or that are exempt from providing coverage 12 for medication therapy management. The bill directs the 13 commissioner of insurance to adopt rules pursuant to Code 14 chapter 17A regarding coverage of benefits for medication 15 therapy management based on specific provisions. 16 The bill also directs the board of pharmacy to adopt rules 17 for the regulation of medication therapy management, based on 18 recommendations of an advisory group comprised of an equal 19 number of physicians and pharmacists who practice medication 20 therapy management; as recommended by interested organizations 21 specified in the bill. 22 -4- LSB 5295HV (3) 83 pf/rj 4/ 4