House Study Bill 89 - Introduced HOUSE FILE _____ BY (PROPOSED COMMITTEE ON PUBLIC SAFETY BILL BY CHAIRPERSON BAUDLER) A BILL FOR An Act relating to controlled substances, including reporting 1 under the drug prescribing and dispensing information 2 program and insurance coverage for abuse-deterrent opioid 3 analgesic drugs, and making penalties applicable. 4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 5 TLSB 2302YC (4) 87 tr/nh

H.F. _____ Section 1. Section 124.552, subsection 1, unnumbered 1 paragraph 1, Code 2017, is amended to read as follows: 2 Each licensed pharmacy that dispenses controlled substances 3 identified pursuant to section 124.554, subsection 1 , 4 paragraph “g” , to patients in the state, and each licensed 5 pharmacy located in the state that dispenses such controlled 6 substances identified pursuant to section 124.554, subsection 7 1 , paragraph “g” , to patients inside or outside the state, 8 unless specifically excepted in this section or by rule, shall 9 submit the following prescription information to the program 10 every day : 11 Sec. 2. NEW SECTION . 514C.31 Opioid analgesic drug products 12 —— coverage. 13 1. Definitions. For purposes of this section, unless the 14 context otherwise requires: 15 a. “Abuse-deterrent opioid analgesic drug product” means a 16 brand-name or generic opioid analgesic drug product approved 17 by the United States food and drug administration with 18 abuse-deterrence labeling claims that indicate the product 19 is expected to result in a meaningful reduction in abuse of 20 opioids. 21 b. “Carrier” means an entity that provides health benefit 22 plans in this state. 23 c. “Health benefit plan” means a policy, certificate, or 24 contract providing hospital or medical coverage, benefits, or 25 services rendered by a health care provider. 26 d. “Opioid analgesic drug product” means a drug product in 27 the opioid analgesic drug class prescribed to treat moderate 28 to severe pain or other conditions and includes immediate 29 release, extended release, and long-acting forms, whether or 30 not combined with other drug substances to form a single drug 31 product or dosage form. 32 2. Coverage required. 33 a. Notwithstanding the uniformity of treatment requirements 34 of section 514C.6, a contract, policy, or plan providing for 35 -1- LSB 2302YC (4) 87 tr/nh 1/ 4

H.F. _____ third-party payment or prepayment of health or medical expenses 1 that provides coverage benefits for opioid analgesic drug 2 products shall provide coverage for an abuse-deterrent opioid 3 analgesic drug product as a preferred drug on the carrier’s 4 drug formulary or preferred drug list. 5 b. Cost-sharing requirements for abuse-deterrent 6 opioid analgesic drug products shall not exceed the lowest 7 cost-sharing requirements applied to other covered prescription 8 drugs on the carrier’s drug formulary or preferred drug list. 9 3. Prior authorization. 10 a. A prior authorization or utilization review requirement 11 shall not require prior use of an opioid analgesic drug product 12 other than an abuse-deterrent opioid analgesic drug product 13 as a prerequisite for access to an abuse-deterrent opioid 14 analgesic drug product. 15 b. This subsection shall not be construed to prevent 16 a carrier from requiring prior authorization for an 17 abuse-deterrent opioid analgesic drug product, provided that 18 the same prior authorization requirements are applied to all 19 versions of the same opioid analgesic drug products that are 20 not abuse-deterrent opioid analgesic drug products. 21 4. Applicability. 22 a. This section applies to the following classes of 23 third-party payment provider contracts or policies delivered, 24 issued for delivery, continued, or renewed in this state on or 25 after July 1, 2017: 26 (1) Individual or group accident and sickness insurance 27 providing coverage on an expense-incurred basis. 28 (2) An individual or group hospital or medical service 29 contract issued pursuant to chapter 509, 514, or 514A. 30 (3) An individual or group health maintenance organization 31 contract regulated under chapter 514B. 32 (4) Any other entity engaged in the business of insurance, 33 risk transfer, or risk retention, which is subject to the 34 jurisdiction of the commissioner. 35 -2- LSB 2302YC (4) 87 tr/nh 2/ 4

H.F. _____ (5) A plan established pursuant to chapter 509A for public 1 employees. 2 (6) An organized delivery system licensed by the director 3 of public health. 4 b. This section shall not apply to accident-only, 5 specified disease, short-term hospital or medical, hospital 6 confinement indemnity, credit, dental, vision, Medicare 7 supplement, long-term care, basic hospital and medical-surgical 8 expense coverage as defined by the commissioner, disability 9 income insurance coverage, coverage issued as a supplement 10 to liability insurance, workers’ compensation or similar 11 insurance, or automobile medical payment insurance. 12 EXPLANATION 13 The inclusion of this explanation does not constitute agreement with 14 the explanation’s substance by the members of the general assembly. 15 Currently, pharmacies licensed under Code chapter 155A that 16 dispense controlled substances are required to submit certain 17 prescription information to the board of pharmacy’s information 18 program for drug prescribing and dispensing. Board of pharmacy 19 rules specify that information must be submitted on a weekly 20 basis. This bill requires the information to be submitted 21 every day. 22 According to Code section 124.558, a pharmacist, pharmacy, 23 prescribing practitioner, or agent of a pharmacist or 24 prescribing practitioner who knowingly fails to comply with the 25 bill shall be subject to disciplinary action by the appropriate 26 professional licensing board. 27 The bill requires a “carrier”, defined by the bill as a 28 provider of health benefit plans in this state, to provide 29 coverage for abuse-deterrent opioid analgesic drug products as 30 a preferred drug on the carrier’s drug formulary or preferred 31 drug list. The bill requires cost-sharing requirements for 32 these products not exceed the lowest cost-sharing requirements 33 applied to other drugs on the carrier’s formulary or preferred 34 drug list. 35 -3- LSB 2302YC (4) 87 tr/nh 3/ 4

H.F. _____ The bill defines “abuse-deterrent opioid analgesic 1 drug product” as a brand-name or generic opioid analgesic 2 drug product approved by the United States food and drug 3 administration with abuse-deterrence labeling claims that 4 indicate the product is expected to result in a meaningful 5 reduction in abuse of opioids. 6 The bill applies to the following classes of third-party 7 payment provider contracts or policies delivered, issued for 8 delivery, continued, or renewed in this state on or after July 9 1, 2017: individual or group accident and sickness insurance 10 providing coverage on an expense-incurred basis; an individual 11 or group hospital or medical service contract issued pursuant 12 to Code chapter 509, 514, or 514A; an individual or group 13 health maintenance organization contract regulated under Code 14 chapter 514B; any other entity engaged in the business of 15 insurance, risk transfer, or risk retention, which is subject 16 to the jurisdiction of the insurance commissioner; a plan 17 established pursuant to Code chapter 509A for public employees; 18 and an organized delivery system licensed by the director of 19 public health. 20 The bill does not apply to accident-only, specified disease, 21 short-term hospital or medical, hospital confinement indemnity, 22 credit, dental, vision, Medicare supplement, long-term care, 23 basic hospital and medical-surgical expense coverage as defined 24 by the commissioner, disability income insurance coverage, 25 coverage issued as a supplement to liability insurance, 26 workers’ compensation or similar insurance, or automobile 27 medical payment insurance. 28 -4- LSB 2302YC (4) 87 tr/nh 4/ 4