H.F. 448 Section 1. Section 155A.3, Code 2021, is amended by adding 1 the following new subsections: 2 NEW SUBSECTION . 18A. “Generic” means a chemically 3 equivalent copy of a brand-name drug with an expired patent. 4 NEW SUBSECTION . 44A. “Self-administered hormonal 5 contraceptive” means a self-administered hormonal contraceptive 6 that is approved by the United States food and drug 7 administration to prevent pregnancy. 8 Sec. 2. NEW SECTION . 155A.47 Pharmacist dispensing of 9 self-administered hormonal contraceptives —— limitations of 10 liability. 11 1. Notwithstanding any provision of law to the contrary, 12 a pharmacist may dispense a self-administered hormonal 13 contraceptive to a patient pursuant to a prescription in 14 accordance with the following: 15 a. For an initial dispensing of a self-administered 16 hormonal contraceptive, the pharmacist may dispense only up 17 to a three-month supply at one time of the self-administered 18 hormonal contraceptive. 19 b. For any subsequent dispensing of the same 20 self-administered hormonal contraceptive, the pharmacist 21 may dispense up to a twelve-month supply at one time 22 of the self-administered hormonal contraceptive. For 23 the purposes of this paragraph, subsequent dispensing 24 of the same self-administered hormonal contraceptive 25 includes the subsequent dispensing of a generic form of 26 self-administered hormonal contraceptive in place of a 27 brand-name self-administered hormonal contraceptive. 28 2. A pharmacist who dispenses a self-administered hormonal 29 contraceptive in compliance with this section shall be 30 immune from criminal and civil liability arising from any 31 damages caused by the dispensing, administering, or use of a 32 self-administered hormonal contraceptive, provided that the 33 pharmacist acts reasonably and in good faith. 34 3. The board shall adopt rules pursuant to chapter 17A to 35 -1- LSB 2340HH (4) 89 pf/rh 1/ 7

H.F. 448 administer this section. 1 Sec. 3. Section 514C.19, Code 2021, is amended to read as 2 follows: 3 514C.19 Prescription contraceptive coverage. 4 1. Notwithstanding the uniformity of treatment requirements 5 of section 514C.6 , a group policy , or contract , or plan 6 providing for third-party payment or prepayment of health or 7 medical expenses shall not do either of the following comply 8 as follows : 9 a. Exclude Such policy, contract, or plan shall not 10 exclude or restrict benefits for prescription contraceptive 11 drugs or prescription contraceptive devices which prevent 12 conception and which are approved by the United States 13 food and drug administration, or generic equivalents 14 approved as substitutable by the United States food and 15 drug administration, if such policy , or contract , or plan 16 provides benefits for other outpatient prescription drugs 17 or devices. However, such policy, contract, or plan shall 18 specifically provide for payment for a self-administered 19 hormonal contraceptive, as prescribed by a practitioner as 20 defined in section 155A.3, and dispensed by a pharmacist 21 pursuant to section 155A.47, including payment for up to 22 an initial three-month supply of the self-administered 23 hormonal contraceptive dispensed at one time and for up to a 24 twelve-month supply of the same self-administered hormonal 25 contraceptive subsequently dispensed at one time. 26 b. Exclude Such policy, contract, or plan shall not exclude 27 or restrict benefits for outpatient contraceptive services 28 which are provided for the purpose of preventing conception if 29 such policy , or contract , or plan provides benefits for other 30 outpatient services provided by a health care professional. 31 2. A person who provides a group policy , or contract , or 32 plan providing for third-party payment or prepayment of health 33 or medical expenses which is subject to subsection 1 shall not 34 do any of the following: 35 -2- LSB 2340HH (4) 89 pf/rh 2/ 7

H.F. 448 a. Deny to an individual eligibility, or continued 1 eligibility, to enroll in or to renew coverage under the terms 2 of the policy , or contract , or plan because of the individual’s 3 use or potential use of such prescription contraceptive drugs 4 or devices, or use or potential use of outpatient contraceptive 5 services. 6 b. Provide a monetary payment or rebate to a covered 7 individual to encourage such individual to accept less than the 8 minimum benefits provided for under subsection 1 . 9 c. Penalize or otherwise reduce or limit the reimbursement 10 of a health care professional because such professional 11 prescribes contraceptive drugs or devices, or provides 12 contraceptive services. 13 d. Provide incentives, monetary or otherwise, to a health 14 care professional to induce such professional to withhold 15 from a covered individual contraceptive drugs or devices, or 16 contraceptive services. 17 3. This section shall not be construed to prevent a 18 third-party payor from including deductibles, coinsurance, or 19 copayments under the policy , or contract, or plan as follows: 20 a. A deductible, coinsurance, or copayment for benefits 21 for prescription contraceptive drugs shall not be greater than 22 such deductible, coinsurance, or copayment for any outpatient 23 prescription drug for which coverage under the policy , or 24 contract , or plan is provided. 25 b. A deductible, coinsurance, or copayment for benefits for 26 prescription contraceptive devices shall not be greater than 27 such deductible, coinsurance, or copayment for any outpatient 28 prescription device for which coverage under the policy , or 29 contract , or plan is provided. 30 c. A deductible, coinsurance, or copayment for benefits for 31 outpatient contraceptive services shall not be greater than 32 such deductible, coinsurance, or copayment for any outpatient 33 health care services for which coverage under the policy , or 34 contract , or plan is provided. 35 -3- LSB 2340HH (4) 89 pf/rh 3/ 7

H.F. 448 4. This section shall not be construed to require a 1 third-party payor under a policy , or contract , or plan 2 to provide benefits for experimental or investigational 3 contraceptive drugs or devices, or experimental or 4 investigational contraceptive services, except to the extent 5 that such policy , or contract , or plan provides coverage for 6 other experimental or investigational outpatient prescription 7 drugs or devices, or experimental or investigational outpatient 8 health care services. 9 5. This section shall not be construed to limit or otherwise 10 discourage the use of generic equivalent drugs approved by the 11 United States food and drug administration, whenever available 12 and appropriate. This section , when a brand name drug is 13 requested by a covered individual and a suitable generic 14 equivalent is available and appropriate, shall not be construed 15 to prohibit a third-party payor from requiring the covered 16 individual to pay a deductible, coinsurance, or copayment 17 consistent with subsection 3 , in addition to the difference of 18 the cost of the brand name drug less the maximum covered amount 19 for a generic equivalent. 20 6. A person who provides an individual policy , or contract , 21 or plan providing for third-party payment or prepayment of 22 health or medical expenses shall make available a coverage 23 provision that satisfies the requirements in subsections 24 1 through 5 in the same manner as such requirements are 25 applicable to a group policy , or contract , or plan under those 26 subsections. The policy , or contract , or plan shall provide 27 that the individual policyholder may reject the coverage 28 provision at the option of the policyholder. 29 7. a. This section applies to the following classes of 30 third-party payment provider contracts , or policies , or plans 31 delivered, issued for delivery, continued, or renewed in this 32 state on or after July 1, 2000 January 1, 2022 : 33 (1) Individual or group accident and sickness insurance 34 providing coverage on an expense-incurred basis. 35 -4- LSB 2340HH (4) 89 pf/rh 4/ 7

H.F. 448 (2) An individual or group hospital or medical service 1 contract issued pursuant to chapter 509 , 514 , or 514A . 2 (3) An individual or group health maintenance organization 3 contract regulated under chapter 514B . 4 (4) Any other entity engaged in the business of insurance, 5 risk transfer, or risk retention, which is subject to the 6 jurisdiction of the commissioner. 7 (5) A plan established pursuant to chapter 509A for public 8 employees. 9 b. This section shall not apply to accident-only, 10 specified disease, short-term hospital or medical, hospital 11 confinement indemnity, credit, dental, vision, Medicare 12 supplement, long-term care, basic hospital and medical-surgical 13 expense coverage as defined by the commissioner, disability 14 income insurance coverage, coverage issued as a supplement 15 to liability insurance, workers’ compensation or similar 16 insurance, or automobile medical payment insurance. 17 8. This section shall not be construed to require a 18 third-party payor to provide payment to a practitioner for the 19 dispensing of a self-administered hormonal contraceptive to 20 replace a self-administered hormonal contraceptive that has 21 been dispensed to a covered person and that has been misplaced, 22 stolen, or destroyed. This section shall not be construed to 23 require a third-party payor to replace covered prescriptions 24 that are misplaced, stolen, or destroyed. 25 9. For the purposes of this section, “self-administered 26 hormonal contraceptive” means a self-administered hormonal 27 contraceptive that is approved by the United States food and 28 drug administration to prevent pregnancy. 29 EXPLANATION 30 The inclusion of this explanation does not constitute agreement with 31 the explanation’s substance by the members of the general assembly. 32 This bill relates to the dispensing of self-administered 33 hormonal contraceptives. 34 The bill provides definitions of “generic” and 35 -5- LSB 2340HH (4) 89 pf/rh 5/ 7

H.F. 448 “self-administered hormonal contraceptive” for the purposes of 1 the bill. 2 The bill provides that notwithstanding any provision of law 3 to the contrary, a pharmacist may dispense a self-administered 4 hormonal contraceptive to a patient pursuant to a prescription 5 based upon whether the dispensing is an initial or subsequent 6 dispensing. If the dispensing is the initial dispensing of 7 a self-administered hormonal contraceptive, the pharmacist 8 may dispense only up to a three-month supply at one time. 9 If the dispensing is a subsequent dispensing of the same 10 self-administered hormonal contraceptive, the pharmacist may 11 dispense up to a 12-month supply at one time. Subsequent 12 dispensing of the same self-administered hormonal contraceptive 13 includes the subsequent dispensing of a generic form of 14 self-administered hormonal contraceptive in place of a 15 brand-name self-administered hormonal contraceptive. 16 A pharmacist who dispenses a self-administered hormonal 17 contraceptive in compliance with the bill shall be immune from 18 criminal and civil liability arising from any damages caused by 19 the dispensing, administering, or use of a self-administered 20 hormonal contraceptive, provided that the pharmacist acts 21 reasonably and in good faith. The board of pharmacy shall 22 adopt administrative rules to administer the bill. 23 The bill also requires a group policy, contract, or plan 24 providing for third-party payment or prepayment of health or 25 medical expenses to specifically provide, in any contract, 26 policy, or plan delivered, issued for delivery, continued, 27 or renewed in this state on or after January 1, 2022, for 28 payment for a self-administered hormonal contraceptive, as 29 prescribed by a practitioner and dispensed by a pharmacist 30 pursuant to the bill, including payment for up to an initial 31 three-month supply of the self-administered hormonal 32 contraceptive dispensed at one time and for up to a 12-month 33 supply of the same self-administered hormonal contraceptive 34 subsequently dispensed at one time. This requirement is not to 35 -6- LSB 2340HH (4) 89 pf/rh 6/ 7

H.F. 448 be construed to require a third-party payor to provide payment 1 to a practitioner for the dispensing of a self-administered 2 hormonal contraceptive to replace a self-administered 3 hormonal contraceptive that has been dispensed to a covered 4 person and that has been misplaced, stolen, or destroyed. 5 This requirement also shall not be construed to require a 6 third-party payor to replace covered prescriptions that are 7 misplaced, stolen, or destroyed. 8 -7- LSB 2340HH (4) 89 pf/rh 7/ 7