HSB 99 (LSB 1711YC (5) 87)

HOUSE FILE _____ 

BY  (PROPOSED COMMITTEE ON HUMAN RESOURCES BILL BY CHAIRPERSON FRY)

A BILL FOR

An Act relating to prescription drugs, including the drug prescribing and dispensing information program, medication-assisted treatment insurance and Medicaid coverage, partial dispensing for opioid medication, and allocation of moneys to the pharmaceutical collection and disposal program.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  Section 124.551, Code 2017, is amended by adding the following new subsection:
   NEW SUBSECTION.  3A.  Each board created under chapter 147 that licenses a prescribing practitioner shall develop a process to integrate automatic registration for the program as part of the board’s licensure application and renewal process. Nothing in this subsection shall require a prescribing practitioner to obtain information about a patient from the program.
    Sec. 2.  Section 124.553, subsection 8, Code 2017, is amended to read as follows:
   8.  The board may enter into an agreement with a prescription database or monitoring program operated in a any state bordering this state or in the state of Kansas for the mutual exchange of information. Any agreement entered into pursuant to this subsection shall specify that all the information exchanged pursuant to the agreement shall be used and disseminated in accordance with the laws of this state.
    Sec. 3.  NEW SECTION.  155A.28A  Partial dispensing of prescription for opioid medication.
   1.  a.  Notwithstanding any provision of law to the contrary, a pharmacist may dispense a prescription for an opioid medication in a lesser quantity than the recommended full quantity indicated on the prescription if requested by the patient for whom the prescription is written or the legal guardian of the patient for whom the prescription is written.
   b.  If a pharmacist partially dispenses a prescription in accordance with this section, the remaining quantity of the prescription not dispensed shall not be dispensed without a new prescription.
   2.  If a pharmacist partially dispenses a prescription for an opioid medication in accordance with this section, the pharmacist or an authorized agent of the pharmacist shall, as soon as is practicable but not more than seven days after the partial dispensing, notify the prescriber of the quantity of the opioid medication actually dispensed. The notice may be conveyed to the prescriber by a notation on the patient’s electronic health record, electronic transmission, facsimile, or telephone.
    Sec. 4.  Section 155A.43, Code 2017, is amended to read as follows:
   155A.43  Pharmaceutical collection and disposal program —— annual allocation.
   Of the fees collected pursuant to sections 124.301 and 147.80 and this chapter 155A by the board of pharmacy, and retained by the board pursuant to section 147.82, not more than one hundred seventy-five thousand dollars may be allocated the board may annually by the board allocate an adequate sum for administering the pharmaceutical collection and disposal program originally established pursuant to 2009 Iowa Acts, ch. 175, §9. The program shall provide for the management and disposal of unused, excess, and expired pharmaceuticals including the management and disposal of controlled substances pursuant to state and federal regulations. The board of pharmacy may cooperate contract with the Iowa pharmacy association and may consult with the department and sanitary landfill operators in administering or with one or more vendors for the provision of supplies and services to manage and maintain the program and to safely and appropriately dispose of pharmaceuticals collected through the program.
    Sec. 5.  NEW SECTION.  514C.31  Medication-assisted treatment coverage.
   1.  As used in this section:
   a.  “Behavioral therapy” means individual, family, or group therapy designed to help a patient engage in the treatment process, modify the patient’s attitudes and behaviors related to substance use, and increase healthy life skills.
   b.  “Financial requirements” means deductibles, copayments, coinsurance, or out-of-pocket maximums.
   c.  “Health care professional” means the same as defined in section 135.154.
   d.  “Medication-assisted treatment” means the use of medications, commonly in combination with counseling and behavioral therapies, to provide a comprehensive approach to the treatment of substance-related disorders. 
   e.  “Pharmacologic therapy” means a prescribed course of treatment that may include methadone, buprenorphine, naloxone, naltrexone, or other federal food and drug administration-approved or evidence-based medications for the treatment of substance-related disorders.
   f.  “Substance-related disorder” means the same as defined in section 125.2.
   2.  Notwithstanding the uniformity of treatment requirements of section 514C.6, a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses shall provide coverage benefits for medication-assisted treatment. Such benefits shall provide coverage for but not be limited to pharmacologic therapies and behavioral therapies.
   3.  Medication-assisted treatment coverage benefits provided for under this section shall not be subject to any of the following:
   a.  Any annual or lifetime dollar limitations.
   b.  Limitations to a predesignated facility, specific number of visits, days of coverage, days in a waiting period, scope or duration of treatment, or other similar limits.
   c.  Different financial requirements than for other illnesses covered under the policy, contract, or plan.
   d.  Step therapy, fail-first, or other similar drug utilization strategies or policies for covered persons that may conflict with a prescribed course of treatment from a licensed health care professional.
   4.  Requirements for coverage under this section shall not be subject to a covered person’s prior successes or failures associated with the services provided.
   5.  The provisions of this section shall apply to all third-party payment provider contracts, policies, or plans delivered, issued for delivery, continued, or renewed in this state on or after July 1, 2017.
   6.  Any contract provision, written policy, or written procedure in violation of this section shall be unenforceable and null and void.
    Sec. 6.  MEDICAID MEDICATION-ASSISTED TREATMENT MEDICATIONS AND SERVICES.  The department of human services shall adopt rules pursuant to chapter 17A to require the Iowa Medicaid program to cover the medication-assisted treatment medications and services provided for under section 514C.31, as enacted in this Act, and include those medication-assisted treatment medications in its preferred drug lists for the treatment of substance-related disorders and prevention of overdose and death. The list of medication-assisted treatment medications provided for under section 514C.31, as enacted in this Act, shall not be deemed to be exclusive, and, as new formulations and medications are approved by the federal food and drug administration for use in the treatment of substance-related disorders, the Iowa Medicaid program shall update its preferred drug lists.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill makes several changes to the drug prescribing and dispensing program maintained by the board of pharmacy in accordance with Code chapter 124. The bill requires each board created under Code chapter 147 that licenses a prescribing practitioner to develop a process to integrate automatic registration for the program as part of that board’s licensure application and renewal process.
   Currently, the board of pharmacy may enter into an agreement with a prescription database or monitoring program operated in Kansas or a state bordering Iowa. The bill allows the board to enter into such an agreement with a program operated in any state. 
   The bill allows a pharmacist to dispense a prescription for an opioid medication in a lesser quantity than the recommended full quantity indicated on the prescription if requested by the patient for whom the prescription is written or the patient’s legal guardian. If a pharmacist does this, the remaining quantity of the prescription shall not be dispensed without a new prescription. Also, the pharmacist or an authorized agent of the pharmacist shall, as soon as is practicable but not more than seven days after the partial dispensing, notify the prescriber of the quantity of the opioid medication actually dispensed. 
   Currently, the board of pharmacy may annually allocate not more than $175,000 for administering the pharmaceutical collection and disposal program. The bill allows the board of pharmacy to allocate an adequate sum for the program every year. The bill also allows the board of pharmacy to contract with one or more vendors for the provision of supplies and services to manage and maintain the program and to safely and appropriately dispose of pharmaceuticals collected through the program.
   The bill establishes requirements for insurance coverage for “medication-assisted treatment”, defined by the bill as the use of medications, commonly in combination with counseling and behavioral therapies, to provide a comprehensive approach to the treatment of substance-related disorders. The bill specifies that all policies, contracts, or plans for third-party payment of health or medical benefits must provide coverage for medication-assisted treatment including but not limited to pharmacologic and behavioral therapies. The bill nullifies any contract provision, written policy, or written procedure in violation of the bill.
   The bill directs the department of human services to adopt rules to require the Iowa Medicaid program to cover medication-assisted treatment medications and services and include those medications in its preferred drug lists for the treatment of substance-related disorders and prevention of overdose and death.