SF 413 (LSB 2342XS (3) 90)

SENATE FILE 413

BY  WEINER

A BILL FOR

An Act relating to insurance coverage for prescription drugs used to treat substance use disorders.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  NEW SECTION.  514C.36  Prescription drugs —— substance use disorders.
   1.  As used in this section, unless the context otherwise requires:
   a.  “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 that provides coverage for prescription drugs.
   b.  “Health care professional” means the same as defined in section 514J.102.
   c.  “Health carrier” means the same as defined in section 514J.102.
   d.  “Prescription drug” means a prescription medication, including an injectable medication, that has been prescribed as medically necessary by a covered person’s health care professional.
   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 all prescription drugs approved by the United States food and drug administration to treat substance use disorders.
   b.  Coverage required under this section shall not be less favorable than coverage a health carrier offers for general physical illness.
   c.  Cost-sharing imposed for coverage required under this section shall not be less favorable than cost-sharing a health carrier imposes for general physical illness.
   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, 2024:
   (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.
   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 insurance coverage for prescription drugs used to treat substance use disorders.
   The bill requires policies, contracts, or plans providing for third-party payment or prepayment of health or medical expenses that provide coverage for prescription drugs to provide coverage for all prescription drugs approved by the United States food and drug administration to treat substance use disorders. “Prescription drug” is defined in the bill as prescription medication, including an injectable medication, that has been prescribed as medically necessary by a covered person’s health care professional.
   Coverage required under the bill shall not be less favorable than coverage a health carrier offers for general physical illness. Cost-sharing imposed for coverage required under the bill shall not be less favorable than cost-sharing a health carrier imposes for general physical illness.
   The bill applies to the third-party payment providers enumerated in the bill. The bill specifies the types of specialized health-related insurance which are not subject to the bill.
   The commissioner of insurance may adopt rules to administer the bill.
   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, 2024.