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 HF 2138 (5) 88 ko/rn/md
H.F. 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 -1- HF 2138 (5) 88 ko/rn/md 1/ 2
H.F. 2138 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 -2- HF 2138 (5) 88 ko/rn/md 2/ 2