House File 447 - Introduced HOUSE FILE 447 BY McKEAN and JAMES A BILL FOR An Act relating to the dispensing of insulin in emergency 1 situations, and providing for insurance coverage. 2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 3 TLSB 2581YH (1) 88 pf/rh

H.F. 447 Section 1. Section 155A.29, Code 2019, is amended to read 1 as follows: 2 155A.29 Prescription refills. 3 1. Except as specified in subsection 2 or 3 , a prescription 4 for any prescription drug or device which is not a controlled 5 substance shall not be filled or refilled more than eighteen 6 months after the date on which the prescription was issued and 7 a prescription which is authorized to be refilled shall not be 8 refilled more than twelve times. 9 2. A pharmacist may exercise professional judgment by 10 refilling a prescription without prescriber authorization if 11 all of the following are true: 12 a. The pharmacist is unable to contact the prescriber after 13 reasonable effort efforts . 14 b. Failure to refill the prescription might result in 15 an interruption of therapeutic regimen or create patient 16 suffering. 17 c. The pharmacist informs the patient or the patient’s 18 representative at the time of dispensing, and the practitioner 19 at the earliest convenience that prescriber reauthorization is 20 required. 21 3. d. Prescriptions may be refilled once pursuant to 22 subsection 2 for a period of time reasonably necessary for the 23 pharmacist to secure prescriber authorization. 24 3. a. In addition to the authorization for a pharmacist to 25 refill a prescription without prescriber authorization pursuant 26 to subsection 2, a pharmacist may exercise professional 27 judgment and refill a prescription for and dispense insulin 28 without prescriber authorization if all of the following 29 conditions are met: 30 (1) The pharmacy has a record of the patient’s expired 31 prescription. 32 (2) The pharmacist is unable to contact the prescriber after 33 reasonable efforts. 34 (3) The insulin is essential to the health of the patient 35 -1- LSB 2581YH (1) 88 pf/rh 1/ 3

H.F. 447 and the patient will be harmed if the insulin is not dispensed. 1 b. The pharmacist may dispense insulin pursuant to this 2 subsection in an amount not to exceed a thirty-day supply and 3 only once in a twelve-month period. 4 4. An authorization to refill a prescription drug order 5 shall be transmitted to a pharmacy by a prescriber or the 6 prescriber’s authorized agent pursuant to section 155A.27 , 7 except that prescription drug orders for controlled substances 8 shall be transmitted pursuant to section 124.308 , and, if not 9 transmitted directly by the practitioner, shall also include 10 the name and title of the practitioner’s agent completing the 11 transmission. 12 Sec. 2. NEW SECTION . 514C.18A Insulin coverage. 13 1. Notwithstanding the uniformity of treatment requirements 14 of section 514C.6, a policy or contract providing for 15 third-party payment or prepayment of insulin when prescribed 16 by a practitioner as defined in section 155A.3, shall provide 17 coverage for insulin dispensed without authorization pursuant 18 to section 155A.29, subsection 3, for an amount not to exceed a 19 thirty-day supply and only once in a twelve-month period. 20 2. a. This section applies to the following classes of 21 third-party payment provider contracts or policies delivered, 22 issued for delivery, continued, or renewed in this state on or 23 after July 1, 2019: 24 (1) Individual or group accident and sickness insurance 25 providing coverage on an expense-incurred basis. 26 (2) An individual or group hospital or medical service 27 contract issued pursuant to chapter 509, 514, or 514A. 28 (3) An individual or group health maintenance organization 29 contract regulated under chapter 514B. 30 (4) Any other entity engaged in the business of insurance, 31 risk transfer, or risk retention, which is subject to the 32 jurisdiction of the commissioner. 33 (5) A plan established pursuant to chapter 509A for public 34 employees. 35 -2- LSB 2581YH (1) 88 pf/rh 2/ 3

H.F. 447 b. This section shall not apply to accident-only, 1 specified disease, short-term hospital or medical, hospital 2 confinement indemnity, credit, dental, vision, Medicare 3 supplement, long-term care, basic hospital and medical-surgical 4 expense coverage as defined by the commissioner, disability 5 income insurance coverage, coverage issued as a supplement 6 to liability insurance, workers’ compensation or similar 7 insurance, or automobile medical payment insurance. 8 EXPLANATION 9 The inclusion of this explanation does not constitute agreement with 10 the explanation’s substance by the members of the general assembly. 11 This bill provides that in addition to existing provisions 12 relating to the refilling of a prescription without prescriber 13 authorization, a pharmacist may exercise professional judgment 14 and refill a prescription for and dispense insulin without 15 prescriber authorization if the pharmacy has a record of the 16 patient’s expired prescription, the pharmacist is unable 17 to contact the prescriber after reasonable efforts, and 18 the insulin is essential to the health of the patient and 19 the patient will be harmed if the insulin is not dispensed. 20 Under these conditions, a pharmacist may dispense insulin in 21 an amount not to exceed a 30-day supply and only once in a 22 12-month period. 23 The bill also provides that a policy or contract providing 24 for third-party payment or prepayment of insulin when 25 prescribed by a practitioner shall also provide coverage for 26 insulin dispensed without authorization as provided in the 27 bill, for an amount not to exceed a 30-day supply, once in a 28 12-month period. 29 -3- LSB 2581YH (1) 88 pf/rh 3/ 3