H.F. 2203 Section 1. Section 135.185, Code 2026, is amended to read 1 as follows: 2 135.185 Epinephrine auto-injector delivery system supply. 3 1. For purposes of this section , unless the context 4 otherwise requires: 5 a. “Epinephrine auto-injector delivery system ” means the same 6 as provided in section 280.16 . 7 b. “Facility” means a food establishment as defined in 8 section 137F.1 , a carnival as defined in section 88A.1 , a 9 recreational camp, a youth sports facility, or a sports arena. 10 c. “Licensed health care professional” means the same as 11 provided in section 280.16 . 12 d. “Personnel authorized to administer epinephrine” means an 13 employee or agent of a facility who is trained and authorized 14 to administer an epinephrine auto-injector delivery system . 15 2. Notwithstanding any other provision of law to the 16 contrary, a licensed health care professional may prescribe 17 epinephrine auto-injectors delivery systems in the name of a 18 facility to be maintained for use as provided in this section . 19 3. A facility may obtain a prescription for epinephrine 20 auto-injectors delivery systems and maintain a supply of such 21 auto-injectors delivery systems in a secure location at each 22 location where a member of the public may be present for use 23 as provided in this section . A facility that obtains such a 24 prescription shall replace epinephrine auto-injectors delivery 25 systems in the supply upon use or expiration. Personnel 26 authorized to administer epinephrine may possess and administer 27 epinephrine auto-injectors delivery systems from the supply as 28 provided in this section . 29 4. Personnel authorized to administer epinephrine may 30 provide or administer an epinephrine auto-injector delivery 31 system from the facility’s supply to an individual present at 32 the facility if such personnel reasonably and in good faith 33 believe the individual is having an anaphylactic reaction. 34 5. The following persons, provided they have acted 35 -1- LSB 5303HV (1) 91 mb/jh 1/ 9

H.F. 2203 reasonably and in good faith, shall not be liable for 1 any injury arising from the provision, administration, 2 or assistance in the administration of an epinephrine 3 auto-injector delivery system as provided in this section : 4 a. Any personnel authorized to administer epinephrine who 5 provide, administer, or assist in the administration of an 6 epinephrine auto-injector delivery system to an individual 7 present at the facility who such personnel believe to be having 8 an anaphylactic reaction. 9 b. The owner or operator of the facility. 10 c. The prescriber of the epinephrine auto-injector delivery 11 system . 12 6. The department, the board of medicine, the board of 13 nursing, and the board of pharmacy shall adopt rules pursuant 14 to chapter 17A to implement and administer this section , 15 including but not limited to standards and procedures for 16 the prescription, distribution, storage, replacement, and 17 administration of epinephrine auto-injectors delivery systems , 18 and for training and authorization to be required for personnel 19 authorized to administer epinephrine. 20 Sec. 2. Section 280.16, Code 2026, is amended to read as 21 follows: 22 280.16 Self-administration of respiratory distress, asthma, 23 or other airway constricting disease medication, epinephrine 24 auto-injectors delivery systems , bronchodilator canisters, or 25 bronchodilator canisters and spacers. 26 1. Definitions. For purposes of this section : 27 a. “Bronchodilator” means a bronchodilator as recommended 28 by the department of health and human services for treatment 29 of a student’s respiratory distress, asthma, or other airway 30 constricting disease. 31 b. “Bronchodilator canister” means a portable drug 32 delivery device packaged with multiple premeasured doses of a 33 bronchodilator. 34 c. “Epinephrine auto-injector delivery system ” means a 35 -2- LSB 5303HV (1) 91 mb/jh 2/ 9

H.F. 2203 device for immediate self-administration or administration by 1 another trained individual of a measured dose of epinephrine 2 to a person at risk of anaphylaxis , including epinephrine 3 auto-injectors and epinephrine nasal sprays . 4 d. “ Licensed health care professional” means a person 5 licensed under chapter 148 to practice medicine and surgery or 6 osteopathic medicine and surgery, an advanced registered nurse 7 practitioner licensed under chapter 152 or 152E and registered 8 with the board of nursing, or a physician assistant licensed 9 under chapter 148C . 10 e. “Medication” means a drug that meets the definition 11 provided in section 126.2, subsection 8 , has an individual 12 prescription label, is prescribed by a licensed health care 13 professional for a student, and pertains to the student’s 14 respiratory distress, asthma, or other airway constricting 15 disease, or risk of anaphylaxis, and includes but is not 16 limited to a bronchodilator. 17 f. “Self-administration” means a student’s discretionary use 18 of medication prescribed by a licensed health care professional 19 for the student. 20 g. “Spacer” means a holding chamber that is used to optimize 21 the delivery of a bronchodilator to a person’s lungs. 22 2. The board of directors of a school district and the 23 authorities in charge of an accredited nonpublic school shall 24 permit the self-administration of medication or the use of a 25 bronchodilator canister or bronchodilator canister and spacer 26 by a student with respiratory distress, asthma, or other airway 27 constricting disease or the use of an epinephrine auto-injector 28 delivery system by a student with a risk of anaphylaxis if the 29 following conditions are met: 30 a. The student’s parent or guardian provides to the 31 school written authorization for the self-administration 32 of medication, for the use of a bronchodilator canister or 33 a bronchodilator canister and spacer, or for the use of an 34 epinephrine auto-injector delivery system . 35 -3- LSB 5303HV (1) 91 mb/jh 3/ 9

H.F. 2203 b. The student’s parent or guardian provides to the school 1 a written statement from the student’s licensed health care 2 professional containing the following information: 3 (1) The name and purpose of the medication, bronchodilator 4 canister, bronchodilator canister and spacer, or epinephrine 5 auto-injector delivery system . 6 (2) The prescribed dosage. 7 (3) The times at which or the special circumstances under 8 which the medication, bronchodilator canister, bronchodilator 9 canister and spacer, or epinephrine auto-injector delivery 10 system is to be administered. 11 c. The parent or guardian and the school meet the 12 requirements of subsection 3 . 13 3. The school district or accredited nonpublic school 14 shall notify the parent or guardian of the student, in 15 writing, that the school district or accredited nonpublic 16 school and its employees are to incur no liability, except 17 for gross negligence, as a result of any injury arising from 18 self-administration of medication, use of a bronchodilator 19 canister or a bronchodilator canister and spacer, or use of 20 an epinephrine auto-injector delivery system by the student. 21 The parent or guardian of the student shall sign a statement 22 acknowledging that the school district or nonpublic school 23 is to incur no liability, except for gross negligence, as 24 a result of self-administration of medication, use of a 25 bronchodilator canister or a bronchodilator canister and 26 spacer, or use of an epinephrine auto-injector delivery system 27 by the student. A school district or accredited nonpublic 28 school and its employees acting reasonably and in good faith 29 shall incur no liability for any improper use of medication, a 30 bronchodilator canister, a bronchodilator canister and spacer, 31 or an epinephrine auto-injector delivery system as defined in 32 this section or for supervising, monitoring, or interfering 33 with a student’s self-administration of medication, use of 34 a bronchodilator canister or a bronchodilator canister and 35 -4- LSB 5303HV (1) 91 mb/jh 4/ 9

H.F. 2203 spacer, or use of an epinephrine auto-injector delivery system 1 as defined in this section . 2 4. The permission for self-administration of medication, 3 for the use of a bronchodilator canister or a bronchodilator 4 canister and spacer, or for the use of an epinephrine 5 auto-injector delivery system is effective for the school year 6 for which it is granted and shall be renewed each subsequent 7 school year upon fulfillment of the requirements of this 8 section . However, the parent or guardian shall immediately 9 notify the school of any changes in the conditions listed under 10 subsection 2 . 11 5. Provided that the requirements of this section are 12 fulfilled, a student with respiratory distress, asthma, or 13 other airway constricting disease may possess and use the 14 student’s medication and a student with a written statement 15 from a licensed health care professional on file pursuant 16 to subsection 2 , paragraph “a” , may use a bronchodilator 17 canister, a bronchodilator canister and spacer, or an 18 epinephrine auto-injector delivery system while in school, at 19 school-sponsored activities, under the supervision of school 20 personnel, and before or after normal school activities, 21 such as while in before-school or after-school care on 22 school-operated property. If the student misuses this 23 privilege, the privilege may be withdrawn. A school district 24 or nonpublic school shall notify a student’s parent or guardian 25 before withdrawing the privilege to use a bronchodilator 26 canister, a bronchodilator canister and spacer, or an 27 epinephrine auto-injector delivery system . 28 6. Information provided to the school under subsection 2 29 shall be kept on file in the office of the school nurse or, in 30 the absence of a school nurse, the school’s administrator. 31 7. The Iowa school for the deaf and the institutions under 32 the control of the department of health and human services as 33 provided in section 218.1 are exempt from the provisions of 34 this section . 35 -5- LSB 5303HV (1) 91 mb/jh 5/ 9

H.F. 2203 Sec. 3. Section 280.16A, Code 2026, is amended to read as 1 follows: 2 280.16A Epinephrine auto-injector delivery system , 3 bronchodilator canister, or bronchodilator canister and spacer 4 supply. 5 1. For purposes of this section , unless the context 6 otherwise requires: 7 a. “Bronchodilator” means the same as defined in section 8 280.16 . 9 b. “Bronchodilator canister” means the same as defined in 10 section 280.16 . 11 c. “Epinephrine auto-injector delivery system ” means the same 12 as provided in section 280.16 . 13 d. “Licensed health care professional” means the same as 14 provided in section 280.16 . 15 e. “Personnel authorized to administer epinephrine or a 16 bronchodilator” means a school nurse or other employee of a 17 school district or accredited nonpublic school trained and 18 authorized to administer an epinephrine auto-injector delivery 19 system , a bronchodilator canister, or a bronchodilator canister 20 and spacer. 21 f. “School nurse” means a registered nurse holding current 22 licensure recognized by the board of nursing who practices in 23 the school setting to promote and protect the health of the 24 school population by using knowledge from the nursing, social, 25 and public health sciences. 26 g. “Spacer” means the same as defined in section 280.16 . 27 2. Notwithstanding any other provision of law to the 28 contrary, a licensed health care professional may prescribe 29 epinephrine auto-injectors delivery systems , bronchodilator 30 canisters, and bronchodilator canisters and spacers in the 31 name of a school district or accredited nonpublic school to be 32 maintained for use as provided in this section . 33 3. The board of directors in charge of each school district 34 and the authorities in charge of each accredited nonpublic 35 -6- LSB 5303HV (1) 91 mb/jh 6/ 9

H.F. 2203 school may obtain a prescription for epinephrine auto-injectors 1 delivery systems , bronchodilator canisters, and bronchodilator 2 canisters and spacers and maintain a supply of such epinephrine 3 auto-injectors delivery systems , bronchodilator canisters, 4 and bronchodilator canisters and spacers in a secure 5 location at each school for use as provided in this section . 6 The board and the authorities shall replace epinephrine 7 auto-injectors delivery systems , bronchodilator canisters, and 8 bronchodilator canisters and spacers in the supply upon use or 9 expiration. Personnel authorized to administer epinephrine 10 or a bronchodilator may possess and administer epinephrine 11 auto-injectors delivery systems , bronchodilator canisters, or 12 bronchodilator canisters and spacers, as applicable, from the 13 supply as provided in this section . 14 4. Personnel authorized to administer epinephrine or 15 a bronchodilator may provide or administer an epinephrine 16 auto-injector delivery system , a bronchodilator canister, or 17 a bronchodilator canister and spacer, as applicable, from 18 the school’s supply to a student or other individual if such 19 personnel reasonably and in good faith believe the student or 20 other individual is having an anaphylactic reaction or requires 21 treatment for respiratory distress, asthma, or other airway 22 constricting disease. 23 5. The following persons, provided they have acted 24 reasonably and in good faith, shall not be liable for 25 any injury arising from the provision, administration, 26 or assistance in the administration of an epinephrine 27 auto-injector delivery system , a bronchodilator canister, or a 28 bronchodilator canister and spacer as provided in this section : 29 a. Any personnel authorized to administer epinephrine or 30 a bronchodilator who, as applicable, provide, administer, or 31 assist in the administration of an epinephrine auto-injector 32 delivery system to a student or other individual present at the 33 school who such personnel believe to be having an anaphylactic 34 reaction or in the administration of a bronchodilator canister 35 -7- LSB 5303HV (1) 91 mb/jh 7/ 9

H.F. 2203 or a bronchodilator canister and spacer to a student or other 1 individual present at the school who such personnel believe to 2 require treatment for respiratory distress, asthma, or other 3 airway constricting disease. 4 b. A school district or accredited nonpublic school 5 employing the personnel. 6 c. The board of directors in charge of the school district 7 or authorities in charge of the accredited nonpublic school. 8 d. The prescriber of the epinephrine auto-injector delivery 9 system , the bronchodilator canister, or the bronchodilator 10 canister and spacer. 11 6. The department of education, the board of medicine, 12 the board of nursing, and the board of pharmacy shall, in 13 consultation with an organization representing school nurses, 14 adopt rules pursuant to chapter 17A to implement and administer 15 this section , including but not limited to standards and 16 procedures for the prescription, distribution, storage, 17 disposal, replacement, and administration of epinephrine 18 auto-injectors delivery systems , bronchodilator canisters, 19 and bronchodilator canisters and spacers, and for training 20 and authorization to be required for personnel authorized to 21 administer epinephrine or a bronchodilator. 22 EXPLANATION 23 The inclusion of this explanation does not constitute agreement with 24 the explanation’s substance by the members of the general assembly. 25 This bill relates to epinephrine delivery systems in 26 schools, food establishments, carnivals, recreational camps, 27 youth sports facilities, and sports arenas. 28 Current law permits food establishments, carnivals, 29 recreational camps, youth sports facilities, and sports arenas 30 to obtain and maintain a supply of epinephrine auto-injectors 31 for emergency use. Current law also requires the board 32 of directors of a school district and the authorities in 33 charge of an accredited nonpublic school to permit the 34 self-administration of medication or the use of an epinephrine 35 -8- LSB 5303HV (1) 91 mb/jh 8/ 9

H.F. 2203 auto-injector by a student with a risk of anaphylaxis if 1 certain conditions are met. Current law further authorizes the 2 board of directors in charge of each school district and the 3 authorities in charge of each accredited nonpublic school to 4 obtain a prescription for epinephrine auto-injectors and to 5 maintain a supply of such devices in a secure location at each 6 school. 7 The bill replaces the defined term “epinephrine 8 auto-injector” with “epinephrine delivery system”, which 9 includes both epinephrine auto-injectors and epinephrine 10 nasal sprays. As a result, under the bill, epinephrine nasal 11 sprays would be permitted and available in the same manner as 12 epinephrine auto-injectors. 13 -9- LSB 5303HV (1) 91 mb/jh 9/ 9