Senate
File
2113
-
Introduced
SENATE
FILE
2113
BY
KOELKER
A
BILL
FOR
An
Act
relating
to
insurance
coverage
for
prescription
insulin
1
drugs.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
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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
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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
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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
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