HF 2511 (LSB 5665YH (1) 89)

HOUSE FILE 2511

BY  JAMES

A BILL FOR

An Act relating to prescription refills in emergency situations and insurance coverage for prescription insulin.
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 insulin drugs —— 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. 
   c.  “Health care professional” means the same as defined in section 514J.102.
   d.  “Prescription insulin drug” means a prescription drug that contains insulin, is used to treat diabetes, that has been prescribed as medically necessary by a covered person’s health care professional, and is a benefit covered by the covered person’s policy, contract, or plan. 
   2.  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 cap the total amount of cost-sharing that a covered person is required to pay per prescription filled to an amount not to exceed twenty-five dollars for up to a thirty-one day supply of at least one type of each of the following: 
   a.  Rapid-acting prescription insulin drugs.
   b.  Short-acting prescription insulin drugs.
   c.  Intermediate-acting prescription insulin drugs.
   d.  Long-acting prescription insulin drugs.
   3.  Nothing in this section shall be construed to prohibit a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses from reducing a covered person’s cost-sharing obligation by an amount greater than the amount specified pursuant to subsection 2.
   4.  a.  This section shall apply 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)  A plan established for public employees pursuant to chapter 509A.
   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 of insurance, disability income insurance coverage, coverage issued as a supplement to liability insurance, workers’ compensation or similar insurance, or automobile medical payment insurance.
   5.  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 prescription refills in emergency situations and insurance coverage for prescription insulin drugs.
   The bill allows a pharmacist to exercise professional judgment and refill a prescription once in a 12-month period and to 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 requires a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses that provides coverage for prescription drugs to cap the total amount of cost-sharing that a covered person is required to pay per prescription filled to an amount not to exceed $25 for up to a 31-day supply of at least one type of each of rapid-acting prescription insulin drugs, short-acting prescription insulin drugs, intermediate-acting prescription insulin drugs, or long-acting prescription insulin drugs. “Prescription insulin drug” is defined in the bill as a prescription drug that contains insulin, is used to treat diabetes, has been prescribed as medically necessary by a covered person’s health care professional, and is a benefit covered by a covered person’s policy, contract, or plan. The bill defines “cost-sharing” as any coverage limit, copayment, coinsurance, deductible, or other out-of-pocket expense imposed on a covered person. A policy, contract, or plan is not prohibited from providing for third-party payment or prepayment of health or medical expenses from reducing a covered person’s cost-sharing to less than $25 for a 31-day supply of a prescription insulin drug. This section of the bill applies to third-party payment provider contracts, policies, or plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2023, by the third-party payment providers enumerated in the bill. The types of specialized health-related insurance which are not subject to the coverage requirements are specified in the bill. The commissioner of insurance may adopt rules to administer the requirements of this section of the bill.