HF 2508 (LSB 5662YH (1) 89)

HOUSE FILE 2508

BY  JAMES

A BILL FOR

An Act relating to the refilling and dispensing of a prescription in emergency situations, including associated insurance coverage.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  Section 155A.29, subsection 3, Code 2022, is amended to read as follows:
   3.  a.  Prescriptions may be refilled once pursuant to subsection 2 for a period of time reasonably necessary for the pharmacist to secure prescriber authorization.
   b.  Notwithstanding paragraph “a”, a prescription may be refilled pursuant to subsection 2 once in a twelve-month period, and the pharmacist may dispense an amount not to exceed a thirty-day supply, or if the standard unit of dispensing exceeds a thirty-day supply or is unit dosed, an amount not to exceed the standard supply or unit of dispensing.
    Sec. 2.  NEW SECTION.  514C.18A  Prescription emergency refills —— coverage.
   1.  As used in this section, unless the context otherwise requires:
   a.  “Cost-sharing” means any coverage limit, copayment, coinsurance, deductible, or other out-of-pocket expense obligation imposed on a covered person by a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses.
   b.  “Covered person” means a policyholder, subscriber, or other person participating in a policy, contract, or plan that provides for third-party payment or prepayment of health or medical expenses.
   2.  a.  Notwithstanding the uniformity of treatment requirements of section 514C.6, a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses that provides coverage for prescription drugs shall provide coverage for a prescription refilled and dispensed pursuant to section 155A.29, subsection 3, paragraph “b”.
   b.  Notwithstanding any cost-sharing obligation imposed under a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses to the contrary, any cost-sharing imposed on a covered person for a prescription refilled and dispensed pursuant to section 155A.29, subsection 3, paragraph “b”, shall not exceed the cost-sharing imposed on the refilling and dispensing of the same prescription with prescriber authorization.
   3.  a.  This section applies to the following classes of third-party payment provider contracts, policies, or plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2023:
   (1)  Individual or group accident and sickness insurance providing coverage on an expense-incurred basis.
   (2)  An individual or group hospital or medical service contract issued pursuant to chapter 509, 514, or 514A.
   (3)  An individual or group health maintenance organization contract regulated under chapter 514B.
   (4)  Any other entity engaged in the business of insurance, risk transfer, or risk retention, which is subject to the jurisdiction of the commissioner.
   (5)  A plan established pursuant to chapter 509A for public employees.
   b.  This section shall not apply to accident-only, specified disease, short-term hospital or medical, hospital confinement indemnity, credit, dental, vision, Medicare supplement, long-term care, basic hospital and medical-surgical expense coverage as defined by the commissioner, disability income insurance coverage, coverage issued as a supplement to liability insurance, workers’ compensation or similar insurance, or automobile medical payment insurance.
   4.  The commissioner of insurance may adopt rules pursuant to chapter 17A to administer this section.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to the emergency refilling and dispensing of a prescription, including associated insurance coverage.
   The bill provides that in addition to existing provisions relating to the refilling of a prescription without prescriber authorization, a pharmacist may exercise professional judgment and refill a prescription once in a 12-month period and may dispense an amount not to exceed a 30-day supply, or if the standard amount of dispensing exceeds a 30-day supply or is unit dosed, an amount not to exceed the standard supply or limit of dispensing.
   The bill also provides that notwithstanding the uniformity of treatment requirements, a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses that provides coverage for prescription drugs shall provide coverage for a prescription refilled and dispensed as provided in the bill. Additionally, notwithstanding any cost-sharing obligation imposed under a policy, contract, or plan to the contrary, any cost-sharing imposed on a covered person for the prescription refilled and dispensed as provided in the bill shall not exceed the cost-sharing imposed on the refilling of the same prescription with prescriber authorization.
   The bill provides definitions of “cost-sharing” and “covered person” for the purposes of this portion of the bill.
   This portion of the bill applies to third-party payment provider contracts, policies, or plans delivered, issued for delivery, continued, or renewed in the state on or after January 1, 2023, including those provider contracts, policies, or plans specified in the bill. The bill also specifies the types of insurance to which the requirements of the bill are not applicable. The commissioner of insurance may adopt administrative rules to administer this portion of the bill.