House
File
2138
-
Reprinted
HOUSE
FILE
2138
BY
COMMITTEE
ON
HUMAN
RESOURCES
(SUCCESSOR
TO
HSB
501)
(As
Amended
and
Passed
by
the
House
March
9,
2020
)
A
BILL
FOR
An
Act
relating
to
insurance
coverage
for
prescription
insulin
1
drugs.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
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2138
Section
1.
NEW
SECTION
.
514C.18A
Prescription
insulin
drugs
1
——
coverage.
2
1.
As
used
in
this
section,
unless
the
context
otherwise
3
requires:
4
a.
“Cost-sharing”
means
any
coverage
limit,
copayment,
5
coinsurance,
deductible,
or
other
out-of-pocket
expense
6
obligation
imposed
on
a
covered
person
by
a
policy,
contract,
7
or
plan
providing
for
third-party
payment
or
prepayment
of
8
health
or
medical
expenses.
9
b.
“Covered
person”
means
a
policyholder,
subscriber,
or
10
other
person
participating
in
a
policy,
contract,
or
plan
that
11
provides
for
third-party
payment
or
prepayment
of
health
or
12
medical
expenses.
13
c.
“Health
care
professional”
means
the
same
as
defined
in
14
section
514J.102.
15
d.
“Prescription
insulin
drug”
means
a
prescription
drug
16
that
contains
insulin,
is
used
to
treat
diabetes,
that
has
been
17
prescribed
as
medically
necessary
by
a
covered
person’s
health
18
care
professional,
and
is
a
benefit
covered
by
the
covered
19
person’s
policy,
contract,
or
plan.
20
2.
Notwithstanding
the
uniformity
of
treatment
requirements
21
of
section
514C.6,
a
policy,
contract,
or
plan
providing
for
22
third-party
payment
or
prepayment
of
health
or
medical
expenses
23
that
provides
coverage
for
prescription
drugs
shall
cap
the
24
total
amount
of
cost-sharing
that
a
covered
person
is
required
25
to
pay
per
prescription
filled
to
an
amount
not
to
exceed
one
26
hundred
dollars
for
up
to
a
thirty-one
day
supply
of
at
least
27
one
type
of
each
of
the
following:
28
a.
Rapid-acting
prescription
insulin
drugs.
29
b.
Short-acting
prescription
insulin
drugs.
30
c.
Intermediate-acting
prescription
insulin
drugs.
31
d.
Long-acting
prescription
insulin
drugs.
32
3.
Nothing
in
this
section
shall
be
construed
to
prohibit
33
a
policy,
contract,
or
plan
providing
for
third-party
payment
34
or
prepayment
of
health
or
medical
expenses
from
reducing
a
35
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covered
person’s
cost-sharing
obligation
by
an
amount
greater
1
than
the
amount
specified
pursuant
to
subsection
2.
2
4.
a.
This
section
shall
apply
to
the
following
classes
3
of
third-party
payment
provider
contracts,
policies,
or
plans
4
delivered,
issued
for
delivery,
continued,
or
renewed
in
this
5
state
on
or
after
January
1,
2021:
6
(1)
Individual
or
group
accident
and
sickness
insurance
7
providing
coverage
on
an
expense-incurred
basis.
8
(2)
An
individual
or
group
hospital
or
medical
service
9
contract
issued
pursuant
to
chapter
509,
514,
or
514A.
10
(3)
An
individual
or
group
health
maintenance
organization
11
contract
regulated
under
chapter
514B.
12
(4)
A
plan
established
for
public
employees
pursuant
to
13
chapter
509A.
14
b.
This
section
shall
not
apply
to
accident-only,
specified
15
disease,
short-term
hospital
or
medical,
hospital
confinement
16
indemnity,
credit,
dental,
vision,
Medicare
supplement,
17
long-term
care,
basic
hospital
and
medical-surgical
expense
18
coverage
as
defined
by
the
commissioner
of
insurance,
19
disability
income
insurance
coverage,
coverage
issued
as
a
20
supplement
to
liability
insurance,
workers’
compensation
or
21
similar
insurance,
or
automobile
medical
payment
insurance.
22
5.
The
commissioner
of
insurance
may
adopt
rules
pursuant
to
23
chapter
17A
to
administer
this
section.
24
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