H.F. 2141 Section 1. NEW SECTION . 146B.1 Prerequisites for 1 prescription to treat erectile dysfunction. 2 1. No person, other than a physician, shall issue to 3 a patient a prescription for a drug intended to treat the 4 symptoms of erectile dysfunction. 5 2. Prior to issuing a prescription for a drug intended to 6 treat the symptoms of erectile dysfunction, a physician shall 7 do all of the following: 8 a. Require at least one of the patient’s sexual partners to 9 be interviewed by the physician and to certify that the patient 10 has experienced symptoms of erectile dysfunction in the ninety 11 days preceding the date of the interview. 12 b. Refer the patient to a person licensed to practice mental 13 health counseling pursuant to chapter 154D for an assessment 14 of the possible causes of the patient’s symptoms of erectile 15 dysfunction and require the patient to provide a written report 16 in which the counselor concludes that the patient’s symptoms 17 are not solely attributable to one or more psychological 18 conditions. 19 c. Conduct a cardiac stress test and obtain a result, 20 described in writing, indicating that the patient’s cardiac 21 health is compatible with sexual activity. 22 d. Notify the patient, in writing, of the potential risks 23 and complications associated with taking drugs intended 24 to treat erectile dysfunction and obtain the patient’s 25 signature on a form acknowledging the patient’s receipt of the 26 notification. 27 e. Declare, in writing, under penalty of perjury, that the 28 drug the physician is prescribing is necessary to treat the 29 patient’s symptoms of erectile dysfunction and attach to the 30 declaration a statement that clearly describes the physician’s 31 medical rationale for issuing the prescription. 32 f. Place all documents described in this subsection 2 in the 33 patient’s medical record and retain the documents as part of 34 that record for at least seven years. 35 -1- LSB 5082YH (3) 86 pf/nh 1/ 4

H.F. 2141 3. To ensure the continued health of a patient to whom 1 a prescription for a drug intended to treat the symptoms of 2 erectile dysfunction has been issued, a physician shall do both 3 of the following as part of the physician’s course of treatment 4 for the patient, including treatment rendered by issuing to the 5 patient a prescription authorizing one or more refills for the 6 drug originally prescribed or a prescription for another drug 7 intended to treat the symptoms of erectile dysfunction: 8 a. Require the patient to undergo a cardiac stress test 9 every ninety days while the patient is taking the drug to 10 ensure that the patient’s cardiac health continues to be 11 compatible with sexual activity. 12 b. Require the patient to attend three sessions of 13 outpatient counseling within the period of six months after 14 the drug is initially prescribed for purposes of ensuring the 15 patient’s understanding of the dangerous side effects of drugs 16 intended to treat the symptoms of erectile dysfunction. The 17 physician shall ensure these sessions include information 18 on nonpharmaceutical treatments for erectile dysfunction, 19 including sexual counseling and resources for patients to 20 pursue celibacy as a viable lifestyle choice. 21 4. As used in this section, “physician” means a person 22 licensed under chapter 148. 23 Sec. 2. Section 148.6, subsection 2, Code 2016, is amended 24 by adding the following new paragraph: 25 NEW PARAGRAPH . j. Failure to comply with the requirements 26 specified in section 146B.1 regarding prescribing of drugs 27 intended to treat the symptoms of erectile dysfunction and the 28 courses of treatment for patients receiving prescriptions for 29 those drugs. 30 EXPLANATION 31 The inclusion of this explanation does not constitute agreement with 32 the explanation’s substance by the members of the general assembly. 33 This bill provides prerequisites for a prescription to treat 34 erectile dysfunction. The bill provides that no person, other 35 -2- LSB 5082YH (3) 86 pf/nh 2/ 4

H.F. 2141 than a physician, shall issue to a patient a prescription for 1 a drug intended to treat symptoms of erectile dysfunction. 2 The bill specifies that prior to issuing a prescription for a 3 drug intended to treat the symptoms of erectile dysfunction, 4 a physician shall do all of the following: (1) require that 5 at least one of the patient’s sexual partners be interviewed 6 by the physician and certify that the patient has experienced 7 symptoms of erectile dysfunction in the 90 days preceding 8 the date of the interview; (2) refer the patient to a person 9 licensed to practice mental health counseling for an assessment 10 of the possible causes of the patient’s symptoms of erectile 11 dysfunction and require the patient to provide a written report 12 in which the counselor concludes that the patient’s symptoms 13 are not solely attributable to one or more psychological 14 conditions; (3) conduct a cardiac stress test and obtain a 15 result, described in writing, indicating that the patient’s 16 cardiac health is compatible with sexual activity; (4) 17 notify the patient, in writing, of the potential risks and 18 complications associated with taking drugs intended to treat 19 erectile dysfunction and obtain the patient’s signature on a 20 form acknowledging the patient’s receipt of the notification; 21 (5) declare, in writing, under penalty of perjury, that the 22 drug the physician is prescribing is necessary to treat the 23 patient’s symptoms of erectile dysfunction and attach to the 24 declaration a statement that clearly describes the physician’s 25 medical rationale for issuing the prescription; and (6) place 26 all such documents in the patient’s medical record and retain 27 the documents as part of that record for at least seven years. 28 Additionally, in order to ensure the continued health 29 of a patient to whom a prescription for a drug intended to 30 treat the symptoms of erectile dysfunction has been issued, a 31 physician is required, as a part of the course of treatment for 32 the patient, including treatment rendered by issuing to the 33 patient a prescription authorizing one or more refills for the 34 drug originally prescribed or a prescription for another drug 35 -3- LSB 5082YH (3) 86 pf/nh 3/ 4

H.F. 2141 intended to treat the symptoms of erectile dysfunction, to both 1 require the patient to undergo a cardiac stress test every 90 2 days while the patient is taking the drug to ensure that the 3 patient’s cardiac health continues to be compatible with sexual 4 activity, and require the patient to attend three sessions of 5 outpatient counseling within the period of six months after 6 the drug is initially prescribed for purposes of ensuring 7 the patient’s understanding of the dangerous side effects of 8 drugs intended to treat the symptoms of erectile dysfunction. 9 The physician is required to ensure these sessions include 10 information on nonpharmaceutical treatments for erectile 11 dysfunction, including sexual counseling and resources for 12 patients to pursue celibacy as a viable lifestyle choice. 13 The bill also provides that failure of a physician to comply 14 with the requirements specified regarding prescribing of drugs 15 intended to treat the symptoms of erectile dysfunction and the 16 courses of treatment for patients receiving prescriptions for 17 those drugs, is grounds for licensee discipline. 18 -4- LSB 5082YH (3) 86 pf/nh 4/ 4