House
File
2053
-
Introduced
HOUSE
FILE
2053
BY
WESSEL-KROESCHELL
and
JAMES
A
BILL
FOR
An
Act
relating
to
limitations
on
cost-sharing
related
to
1
insurance
coverage
of
insulin.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
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2053
Section
1.
NEW
SECTION
.
514C.18A
Prescription
insulin
1
coverage
——
limitations
on
cost-sharing.
2
1.
Notwithstanding
the
uniformity
of
treatment
requirements
3
of
section
514C.6,
a
policy,
contract,
or
plan
providing
for
4
third-party
payment
or
prepayment
of
health
or
medical
expenses
5
that
provides
coverage
for
insulin
when
prescribed
by
a
6
practitioner
as
defined
in
section
155A.3
shall
limit
the
total
7
cost-sharing
amount
that
a
covered
person
is
required
to
pay
8
for
prescription
insulin
to
an
amount
not
to
exceed
one
hundred
9
dollars
per
thirty-day
supply
of
insulin,
regardless
of
the
10
amount
or
type
of
insulin
needed
to
fill
the
covered
person’s
11
prescription.
Nothing
in
this
section
shall
prevent
a
carrier
12
from
reducing
a
covered
person’s
cost-sharing
amount
by
an
13
amount
greater
than
the
maximum
specified
in
this
subsection.
14
2.
a.
This
section
applies
to
the
following
classes
of
15
third-party
payment
provider
policies,
contracts,
or
plans
16
delivered,
issued
for
delivery,
continued,
or
renewed
in
this
17
state
on
or
after
July
1,
2020:
18
(1)
Individual
or
group
accident
and
sickness
insurance
19
providing
coverage
on
an
expense-incurred
basis.
20
(2)
An
individual
or
group
hospital
or
medical
service
21
contract
issued
pursuant
to
chapter
509,
514,
or
514A.
22
(3)
An
individual
or
group
health
maintenance
organization
23
contract
regulated
under
chapter
514B.
24
(4)
Any
other
entity
engaged
in
the
business
of
insurance,
25
risk
transfer,
or
risk
retention,
which
is
subject
to
the
26
jurisdiction
of
the
commissioner.
27
(5)
A
plan
established
pursuant
to
chapter
509A
for
public
28
employees.
29
b.
This
section
shall
not
apply
to
accident-only,
30
specified
disease,
short-term
hospital
or
medical,
hospital
31
confinement
indemnity,
credit,
dental,
vision,
Medicare
32
supplement,
long-term
care,
basic
hospital
and
medical-surgical
33
expense
coverage
as
defined
by
the
commissioner,
disability
34
income
insurance
coverage,
coverage
issued
as
a
supplement
35
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to
liability
insurance,
workers’
compensation
or
similar
1
insurance,
or
automobile
medical
payment
insurance.
2
3.
For
the
purposes
of
this
section,
unless
the
context
3
otherwise
requires,
“cost-sharing
amount”
means
payment
of
a
4
premium,
coinsurance
amount,
deductible
amount,
copayment,
or
5
any
other
cost-sharing
obligation
for
a
covered
person.
6
EXPLANATION
7
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
8
the
explanation’s
substance
by
the
members
of
the
general
assembly.
9
This
bill
limits
the
total
cost-sharing
amount
that
a
10
covered
person
is
required
to
pay
for
covered
prescription
11
insulin
at
an
amount
not
to
exceed
$100
per
30-day
supply
of
12
insulin,
regardless
of
the
amount
or
type
of
insulin
needed
13
to
fill
the
covered
person’s
prescription.
Nothing
in
the
14
bill
prevents
a
carrier
from
reducing
a
covered
person’s
cost
15
sharing
by
an
amount
greater
than
the
maximum
specified
in
the
16
bill.
17
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