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House Study Bill 50 - IntroducedA Bill ForAn Act 1relating to insurance coverage for prescription insulin
2drugs, and including applicability provisions.
3BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 Section 1. NEW SECTION. 514C.18A Prescription insulin drugs
2— coverage.
31. As used in this section, unless the context otherwise
4requires:
5a. “Cost-sharing” means any coverage limit, copayment,
6coinsurance, deductible, or other out-of-pocket expense
7obligation imposed on a covered person by a policy, contract,
8or plan providing for third-party payment or prepayment of
9health or medical expenses.
10b. “Covered person” means a policyholder, subscriber, or
11other person participating in a policy, contract, or plan that
12provides for third-party payment or prepayment of health or
13medical expenses.
14c. “Health care professional” means the same as defined in
15section 514J.102.
16d. “Prescription insulin drug” means a prescription drug
17that contains insulin, is used to treat diabetes, that has been
18prescribed as medically necessary by a covered person’s health
19care professional, and is a benefit covered by the covered
20person’s policy, contract, or plan.
212. Notwithstanding the uniformity of treatment requirements
22of section 514C.6, a policy, contract, or plan providing for
23third-party payment or prepayment of health or medical expenses
24that provides coverage for prescription drugs shall cap the
25total amount of cost-sharing that a covered person is required
26to pay per prescription filled to an amount not to exceed one
27hundred dollars for up to a thirty-one-day supply of at least
28one type of each of the following:
29a. Rapid-acting prescription insulin drugs.
30b. Short-acting prescription insulin drugs.
31c. Intermediate-acting prescription insulin drugs.
32d. Long-acting prescription insulin drugs.
333. Nothing in this section shall be construed to prohibit
34a policy, contract, or plan providing for third-party payment
35or prepayment of health or medical expenses from reducing a
-1-1covered person’s cost-sharing obligation by an amount greater
2than the amount specified pursuant to subsection 2.
34. a. This section shall apply to the following classes of
4third-party payment provider contracts, policies, or plans:
5(1) Individual or group accident and sickness insurance
6providing coverage on an expense-incurred basis.
7(2) An individual or group hospital or medical service
8contract issued pursuant to chapter 509, 514, or 514A.
9(3) An individual or group health maintenance organization
10contract regulated under chapter 514B.
11(4) A plan established for public employees pursuant to
12chapter 509A.
13b. This section shall not apply to accident-only, specified
14disease, short-term hospital or medical, hospital confinement
15indemnity, credit, dental, vision, Medicare supplement,
16long-term care, basic hospital and medical-surgical expense
17coverage as defined by the commissioner of insurance,
18disability income insurance coverage, coverage issued as a
19supplement to liability insurance, workers’ compensation or
20similar insurance, or automobile medical payment insurance.
215. The commissioner of insurance may adopt rules pursuant to
22chapter 17A to administer this section.
23 Sec. 2. APPLICABILITY. This Act applies to third-party
24payment provider contracts, policies, or plans delivered,
25issued for delivery, continued, or renewed in this state on or
26after January 1, 2022.
27EXPLANATION
28The inclusion of this explanation does not constitute agreement with
29the explanation’s substance by the members of the general assembly.
30This bill relates to prescription insulin drugs and coverage
31by policies, contracts, or plans providing for third-party
32payment or prepayment of health or medical expenses that
33provide coverage for prescription drugs.
34The bill requires a policy, contract, or plan providing
35for third-party payment or prepayment of health or medical
-2-1expenses that provides coverage for prescription drugs to
2cap the total amount of cost-sharing that a covered person
3is required to pay per prescription filled to an amount not
4to exceed $100 for up to a 31-day supply of at least one
5type of each of rapid-acting prescription insulin drugs,
6short-acting prescription insulin drugs, intermediate-acting
7prescription insulin drugs, or long-acting prescription insulin
8drugs. “Prescription insulin drug” is defined in the bill as
9a prescription drug that contains insulin, is used to treat
10diabetes, has been prescribed as medically necessary by a
11covered person’s health care professional, and is a benefit
12covered by a covered person’s policy, contract, or plan. The
13bill defines “cost-sharing” as any coverage limit, copayment,
14coinsurance, deductible, or other out-of-pocket expense imposed
15on a covered person.
16The bill does not prohibit a policy, contract, or plan
17providing for third-party payment or prepayment of health or
18medical expenses from reducing a covered person’s cost-sharing
19to less than $100 for a 31-day supply of a prescription insulin
20drug.
21The bill applies to third-party payment provider contracts,
22policies, or plans delivered, issued for delivery, continued,
23or renewed in this state on or after January 1, 2022, by the
24third-party payment providers enumerated in the bill.
25The bill specifies the types of specialized health-related
26insurance which are not subject to the coverage requirements
27of the bill.
28The commissioner of insurance may adopt rules to administer
29the requirements of the bill.
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2drugs, and including applicability provisions.
3BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 Section 1. NEW SECTION. 514C.18A Prescription insulin drugs
2— coverage.
31. As used in this section, unless the context otherwise
4requires:
5a. “Cost-sharing” means any coverage limit, copayment,
6coinsurance, deductible, or other out-of-pocket expense
7obligation imposed on a covered person by a policy, contract,
8or plan providing for third-party payment or prepayment of
9health or medical expenses.
10b. “Covered person” means a policyholder, subscriber, or
11other person participating in a policy, contract, or plan that
12provides for third-party payment or prepayment of health or
13medical expenses.
14c. “Health care professional” means the same as defined in
15section 514J.102.
16d. “Prescription insulin drug” means a prescription drug
17that contains insulin, is used to treat diabetes, that has been
18prescribed as medically necessary by a covered person’s health
19care professional, and is a benefit covered by the covered
20person’s policy, contract, or plan.
212. Notwithstanding the uniformity of treatment requirements
22of section 514C.6, a policy, contract, or plan providing for
23third-party payment or prepayment of health or medical expenses
24that provides coverage for prescription drugs shall cap the
25total amount of cost-sharing that a covered person is required
26to pay per prescription filled to an amount not to exceed one
27hundred dollars for up to a thirty-one-day supply of at least
28one type of each of the following:
29a. Rapid-acting prescription insulin drugs.
30b. Short-acting prescription insulin drugs.
31c. Intermediate-acting prescription insulin drugs.
32d. Long-acting prescription insulin drugs.
333. Nothing in this section shall be construed to prohibit
34a policy, contract, or plan providing for third-party payment
35or prepayment of health or medical expenses from reducing a
-1-1covered person’s cost-sharing obligation by an amount greater
2than the amount specified pursuant to subsection 2.
34. a. This section shall apply to the following classes of
4third-party payment provider contracts, policies, or plans:
5(1) Individual or group accident and sickness insurance
6providing coverage on an expense-incurred basis.
7(2) An individual or group hospital or medical service
8contract issued pursuant to chapter 509, 514, or 514A.
9(3) An individual or group health maintenance organization
10contract regulated under chapter 514B.
11(4) A plan established for public employees pursuant to
12chapter 509A.
13b. This section shall not apply to accident-only, specified
14disease, short-term hospital or medical, hospital confinement
15indemnity, credit, dental, vision, Medicare supplement,
16long-term care, basic hospital and medical-surgical expense
17coverage as defined by the commissioner of insurance,
18disability income insurance coverage, coverage issued as a
19supplement to liability insurance, workers’ compensation or
20similar insurance, or automobile medical payment insurance.
215. The commissioner of insurance may adopt rules pursuant to
22chapter 17A to administer this section.
23 Sec. 2. APPLICABILITY. This Act applies to third-party
24payment provider contracts, policies, or plans delivered,
25issued for delivery, continued, or renewed in this state on or
26after January 1, 2022.
27EXPLANATION
28The inclusion of this explanation does not constitute agreement with
29the explanation’s substance by the members of the general assembly.
30This bill relates to prescription insulin drugs and coverage
31by policies, contracts, or plans providing for third-party
32payment or prepayment of health or medical expenses that
33provide coverage for prescription drugs.
34The bill requires a policy, contract, or plan providing
35for third-party payment or prepayment of health or medical
-2-1expenses that provides coverage for prescription drugs to
2cap the total amount of cost-sharing that a covered person
3is required to pay per prescription filled to an amount not
4to exceed $100 for up to a 31-day supply of at least one
5type of each of rapid-acting prescription insulin drugs,
6short-acting prescription insulin drugs, intermediate-acting
7prescription insulin drugs, or long-acting prescription insulin
8drugs. “Prescription insulin drug” is defined in the bill as
9a prescription drug that contains insulin, is used to treat
10diabetes, has been prescribed as medically necessary by a
11covered person’s health care professional, and is a benefit
12covered by a covered person’s policy, contract, or plan. The
13bill defines “cost-sharing” as any coverage limit, copayment,
14coinsurance, deductible, or other out-of-pocket expense imposed
15on a covered person.
16The bill does not prohibit a policy, contract, or plan
17providing for third-party payment or prepayment of health or
18medical expenses from reducing a covered person’s cost-sharing
19to less than $100 for a 31-day supply of a prescription insulin
20drug.
21The bill applies to third-party payment provider contracts,
22policies, or plans delivered, issued for delivery, continued,
23or renewed in this state on or after January 1, 2022, by the
24third-party payment providers enumerated in the bill.
25The bill specifies the types of specialized health-related
26insurance which are not subject to the coverage requirements
27of the bill.
28The commissioner of insurance may adopt rules to administer
29the requirements of the bill.
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