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 TLSB 5182HH (3) 88 pf/rh
H.F. 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 -1- LSB 5182HH (3) 88 pf/rh 1/ 2
H.F. 2053 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 -2- LSB 5182HH (3) 88 pf/rh 2/ 2