S.F. 2113 Section 1. NEW SECTION . 514C.18A Prescription insulin drugs 1 —— coverage. 1. As used in this section, unless the context otherwise 3 requires: 4 a. “Cost-sharing” means any coverage limit, copayment, 5 coinsurance, deductible, or other out-of-pocket expense 6 obligation imposed on a covered person by a policy, contract, 7 or plan providing for third-party payment or prepayment of 8 health or medical expenses. 9 b. “Covered person” means a policyholder, subscriber, or 10 other person participating in a policy, contract, or plan that 11 provides for third-party payment or prepayment of health or 12 medical expenses. 13 c. “Health care professional” means the same as defined in 14 section 514J.102. 15 d. “Prescription insulin drug” means a prescription drug 16 that contains insulin, is used to treat diabetes, and that has 17 been prescribed as medically necessary by a covered person’s 18 health care professional. 19 2. Notwithstanding the uniformity of treatment requirements 20 of section 514C.6, a policy, contract, or plan providing 21 for third-party payment or prepayment of health or medical 22 expenses that provides coverage for prescription drugs shall 23 cap the total amount of cost-sharing that a covered person is 24 required to pay for a prescription insulin drug to an amount 25 not to exceed one hundred dollars per thirty-day supply of the 26 prescription insulin drug, regardless of the amount or type of 27 prescription insulin drug required to fill the covered person’s 28 prescription. 29 3. Nothing in this section shall be construed to prohibit 30 a policy, contract, or plan providing for third-party payment 31 or prepayment of health or medical expenses from reducing a 32 covered person’s cost-sharing obligation by an amount greater 33 than the amount specified pursuant to subsection 2. 34 4. a. This section shall apply to the following classes 35 -1- LSB 5562XS (1) 88 ko/rn 1/ 3

S.F. 2113 of third-party payment provider contracts, policies, or plans 1 delivered, issued for delivery, continued, or renewed in this 2 state on or after January 1, 2021: 3 (1) Individual or group accident and sickness insurance 4 providing coverage on an expense-incurred basis. 5 (2) An individual or group hospital or medical service 6 contract issued pursuant to chapter 509, 514, or 514A. 7 (3) An individual or group health maintenance organization 8 contract regulated under chapter 514B. 9 (4) A plan established for public employees pursuant to 10 chapter 509A. 11 b. This section shall not apply to accident-only, specified 12 disease, short-term hospital or medical, hospital confinement 13 indemnity, credit, dental, vision, Medicare supplement, 14 long-term care, basic hospital and medical-surgical expense 15 coverage as defined by the commissioner of insurance, 16 disability income insurance coverage, coverage issued as a 17 supplement to liability insurance, workers’ compensation or 18 similar insurance, or automobile medical payment insurance. 19 5. The commissioner of insurance shall adopt rules pursuant 20 to chapter 17A to administer this section. 21 EXPLANATION 22 The inclusion of this explanation does not constitute agreement with 23 the explanation’s substance by the members of the general assembly. 24 This bill relates to prescription insulin drugs and coverage 25 by policies, contracts, or plans providing for third-party 26 payment or prepayment of health or medical expenses that 27 provide coverage for prescription drugs. 28 The bill requires a policy, contract, or plan providing for 29 third-party payment or prepayment of health or medical expenses 30 that provides coverage for prescription drugs to cap the total 31 amount of cost-sharing that a covered person is required to 32 pay for a prescription insulin drug to an amount not more than 33 $100 for a 30-day supply, regardless of the amount or type of 34 prescription insulin drug required to fill the covered person’s 35 -2- LSB 5562XS (1) 88 ko/rn 2/ 3

S.F. 2113 prescription. “Prescription insulin drug” is defined in the 1 bill as a prescription drug that contains insulin, is used 2 to treat diabetes, and that has been prescribed as medically 3 necessary by a covered person’s health care professional. The 4 bill defines “cost-sharing” as any coverage limit, copayment, 5 coinsurance, deductible, or other out-of-pocket expense imposed 6 on a covered person. 7 The bill does not prohibit a policy, contract, or plan 8 providing for third-party payment or prepayment of health or 9 medical expenses from reducing a covered person’s cost-sharing 10 to less than $100 for a 30-day supply of a prescription insulin 11 drug. 12 The bill applies to third-party payment provider contracts, 13 policies, or plans delivered, issued for delivery, continued, 14 or renewed in this state on or after January 1, 2021, by the 15 third-party payment providers enumerated in the bill. 16 The bill specifies the types of specialized health-related 17 insurance which are not subject to the coverage requirements 18 of the bill. 19 The commissioner of insurance is required to adopt rules to 20 administer the requirements of the bill. 21 -3- LSB 5562XS (1) 88 ko/rn 3/ 3