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Senate Study Bill 1134 - IntroducedA Bill ForAn Act 1relating to prescription drugs, including the
2drug prescribing and dispensing information program,
3medication-assisted treatment insurance and Medicaid
4coverage, partial dispensing for opioid medication, and
5allocation of moneys to the pharmaceutical collection and
6disposal program.
7BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 Section 1. Section 124.551, Code 2017, is amended by adding
2the following new subsection:
3 NEW SUBSECTION. 3A. Each board created under chapter
4147 that licenses a prescribing practitioner shall develop a
5process to integrate automatic registration for the program as
6part of the board’s licensure application and renewal process.
7Nothing in this subsection shall require a prescribing
8practitioner to obtain information about a patient from the
9program.
10 Sec. 2. Section 124.553, subsection 8, Code 2017, is amended
11to read as follows:
128. The board may enter into an agreement with a prescription
13database or monitoring program operated in a any state
14bordering this state or in the state of Kansas for the mutual
15exchange of information. Any agreement entered into pursuant
16to this subsection shall specify that all the information
17exchanged pursuant to the agreement shall be used and
18disseminated in accordance with the laws of this state.
19 Sec. 3. NEW SECTION. 155A.28A Partial dispensing of
20prescription for opioid medication.
211. a. Notwithstanding any provision of law to the
22contrary, a pharmacist may dispense a prescription for an
23opioid medication in a lesser quantity than the recommended
24full quantity indicated on the prescription if requested by
25the patient for whom the prescription is written or the legal
26guardian of the patient for whom the prescription is written.
27b. If a pharmacist partially dispenses a prescription in
28accordance with this section, the remaining quantity of the
29prescription not dispensed shall not be dispensed without a new
30prescription.
312. If a pharmacist partially dispenses a prescription for
32an opioid medication in accordance with this section, the
33pharmacist or an authorized agent of the pharmacist shall,
34as soon as is practicable but not more than seven days after
35the partial dispensing, notify the prescriber of the quantity
-1-1of the opioid medication actually dispensed. The notice may
2be conveyed to the prescriber by a notation on the patient’s
3electronic health record, electronic transmission, facsimile,
4or telephone.
5 Sec. 4. Section 155A.43, Code 2017, is amended to read as
6follows:
7155A.43 Pharmaceutical collection and disposal program —
8annual allocation.
9Of the fees collected pursuant to sections 124.301 and
10147.80 and this chapter 155A by the board of pharmacy, and
11retained by the board pursuant to section 147.82, not more than
12one hundred seventy-five thousand dollars may be allocated
13 the board may annually by the board allocate an adequate sum
14 for administering the pharmaceutical collection and disposal
15program originally established pursuant to 2009 Iowa Acts,
16ch.175, §9. The program shall provide for the management
17and disposal of unused, excess, and expired pharmaceuticals
18including the management and disposal of controlled substances
19pursuant to state and federal regulations. The board of
20pharmacy may cooperate contract with the Iowa pharmacy
21association and may consult with the department and sanitary
22landfill operators in administering or with one or more vendors
23for the provision of supplies and services to manage and
24maintain the program and to safely and appropriately dispose of
25pharmaceuticals collected through the program.
26 Sec. 5. NEW SECTION. 514C.31 Medication-assisted treatment
27coverage.
281. As used in this section:
29a. “Behavioral therapy” means individual, family, or group
30therapy designed to help a patient engage in the treatment
31process, modify the patient’s attitudes and behaviors related
32to substance use, and increase healthy life skills.
33b. “Financial requirements” means deductibles, copayments,
34coinsurance, or out-of-pocket maximums.
35c. “Health care professional” means the same as defined in
-2-1section 135.154.
2d. “Medication-assisted treatment” means the use of
3medications, commonly in combination with counseling and
4behavioral therapies, to provide a comprehensive approach to
5the treatment of substance-related disorders.
6e. “Pharmacologic therapy” means a prescribed course
7of treatment that may include methadone, buprenorphine,
8naloxone, naltrexone, or other federal food and drug
9administration-approved or evidence-based medications for the
10treatment of substance-related disorders.
11f. “Substance-related disorder” means the same as defined
12in section 125.2.
132. Notwithstanding the uniformity of treatment requirements
14of section 514C.6, a policy, contract, or plan providing for
15third-party payment or prepayment of health or medical expenses
16shall provide coverage benefits for medication-assisted
17treatment. Such benefits shall provide coverage for but not be
18limited to pharmacologic therapies and behavioral therapies.
193. Medication-assisted treatment coverage benefits provided
20for under this section shall not be subject to any of the
21following:
22a. Any annual or lifetime dollar limitations.
23b. Limitations to a predesignated facility, specific number
24of visits, days of coverage, days in a waiting period, scope or
25duration of treatment, or other similar limits.
26c. Different financial requirements than for other illnesses
27covered under the policy, contract, or plan.
28d. Step therapy, fail-first, or other similar drug
29utilization strategies or policies for covered persons that may
30conflict with a prescribed course of treatment from a licensed
31health care professional.
324. Requirements for coverage under this section shall not
33be subject to a covered person’s prior successes or failures
34associated with the services provided.
355. The provisions of this section shall apply to all
-3-1third-party payment provider contracts, policies, or plans
2delivered, issued for delivery, continued, or renewed in this
3state on or after July 1, 2017.
46. Any contract provision, written policy, or written
5procedure in violation of this section shall be unenforceable
6and null and void.
7 Sec. 6. MEDICAID MEDICATION-ASSISTED TREATMENT MEDICATIONS
8AND SERVICES. The department of human services shall adopt
9rules pursuant to chapter 17A to require the Iowa Medicaid
10program to cover the medication-assisted treatment medications
11and services provided for under section 514C.31, as enacted
12in this Act, and include those medication-assisted treatment
13medications in its preferred drug lists for the treatment of
14substance-related disorders and prevention of overdose and
15death. The list of medication-assisted treatment medications
16provided for under section 514C.31, as enacted in this Act,
17shall not be deemed to be exclusive, and, as new formulations
18and medications are approved by the federal food and drug
19administration for use in the treatment of substance-related
20disorders, the Iowa Medicaid program shall update its preferred
21drug lists.
22EXPLANATION
23The inclusion of this explanation does not constitute agreement with
24the explanation’s substance by the members of the general assembly.
25This bill makes several changes to the drug prescribing
26and dispensing program maintained by the board of pharmacy in
27accordance with Code chapter 124. The bill requires each board
28created under Code chapter 147 that licenses a prescribing
29practitioner to develop a process to integrate automatic
30registration for the program as part of that board’s licensure
31application and renewal process.
32Currently, the board of pharmacy may enter into an agreement
33with a prescription database or monitoring program operated in
34Kansas or a state bordering Iowa. The bill allows the board
35to enter into such an agreement with a program operated in any
-4-1state.
2The bill allows a pharmacist to dispense a prescription for
3an opioid medication in a lesser quantity than the recommended
4full quantity indicated on the prescription if requested by the
5patient for whom the prescription is written or the patient’s
6legal guardian. If a pharmacist does this, the remaining
7quantity of the prescription shall not be dispensed without a
8new prescription. Also, the pharmacist or an authorized agent
9of the pharmacist shall, as soon as is practicable but not
10more than seven days after the partial dispensing, notify the
11prescriber of the quantity of the opioid medication actually
12dispensed.
13Currently, the board of pharmacy may annually allocate
14not more than $175,000 for administering the pharmaceutical
15collection and disposal program. The bill allows the board
16of pharmacy to allocate an adequate sum for the program every
17year. The bill also allows the board of pharmacy to contract
18with one or more vendors for the provision of supplies and
19services to manage and maintain the program and to safely and
20appropriately dispose of pharmaceuticals collected through the
21program.
22The bill establishes requirements for insurance coverage
23for “medication-assisted treatment”, defined by the bill
24as the use of medications, commonly in combination with
25counseling and behavioral therapies, to provide a comprehensive
26approach to the treatment of substance-related disorders. The
27bill specifies that all policies, contracts, or plans for
28third-party payment of health or medical benefits must provide
29coverage for medication-assisted treatment including but not
30limited to pharmacologic and behavioral therapies. The bill
31nullifies any contract provision, written policy, or written
32procedure in violation of the bill.
33The bill directs the department of human services to
34adopt rules to require the Iowa Medicaid program to cover
35medication-assisted treatment medications and services and
-5-1include those medications in its preferred drug lists for the
2treatment of substance-related disorders and prevention of
3overdose and death.
-6-tr/nh
2drug prescribing and dispensing information program,
3medication-assisted treatment insurance and Medicaid
4coverage, partial dispensing for opioid medication, and
5allocation of moneys to the pharmaceutical collection and
6disposal program.
7BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 Section 1. Section 124.551, Code 2017, is amended by adding
2the following new subsection:
3 NEW SUBSECTION. 3A. Each board created under chapter
4147 that licenses a prescribing practitioner shall develop a
5process to integrate automatic registration for the program as
6part of the board’s licensure application and renewal process.
7Nothing in this subsection shall require a prescribing
8practitioner to obtain information about a patient from the
9program.
10 Sec. 2. Section 124.553, subsection 8, Code 2017, is amended
11to read as follows:
128. The board may enter into an agreement with a prescription
13database or monitoring program operated in a any state
14bordering this state or in the state of Kansas for the mutual
15exchange of information. Any agreement entered into pursuant
16to this subsection shall specify that all the information
17exchanged pursuant to the agreement shall be used and
18disseminated in accordance with the laws of this state.
19 Sec. 3. NEW SECTION. 155A.28A Partial dispensing of
20prescription for opioid medication.
211. a. Notwithstanding any provision of law to the
22contrary, a pharmacist may dispense a prescription for an
23opioid medication in a lesser quantity than the recommended
24full quantity indicated on the prescription if requested by
25the patient for whom the prescription is written or the legal
26guardian of the patient for whom the prescription is written.
27b. If a pharmacist partially dispenses a prescription in
28accordance with this section, the remaining quantity of the
29prescription not dispensed shall not be dispensed without a new
30prescription.
312. If a pharmacist partially dispenses a prescription for
32an opioid medication in accordance with this section, the
33pharmacist or an authorized agent of the pharmacist shall,
34as soon as is practicable but not more than seven days after
35the partial dispensing, notify the prescriber of the quantity
-1-1of the opioid medication actually dispensed. The notice may
2be conveyed to the prescriber by a notation on the patient’s
3electronic health record, electronic transmission, facsimile,
4or telephone.
5 Sec. 4. Section 155A.43, Code 2017, is amended to read as
6follows:
7155A.43 Pharmaceutical collection and disposal program —
8annual allocation.
9Of the fees collected pursuant to sections 124.301 and
10147.80 and this chapter 155A by the board of pharmacy, and
11retained by the board pursuant to section 147.82, not more than
12one hundred seventy-five thousand dollars may be allocated
13 the board may annually by the board allocate an adequate sum
14 for administering the pharmaceutical collection and disposal
15program originally established pursuant to 2009 Iowa Acts,
16ch.175, §9. The program shall provide for the management
17and disposal of unused, excess, and expired pharmaceuticals
18including the management and disposal of controlled substances
19pursuant to state and federal regulations. The board of
20pharmacy may cooperate contract with the Iowa pharmacy
21association and may consult with the department and sanitary
22landfill operators in administering or with one or more vendors
23for the provision of supplies and services to manage and
24maintain the program and to safely and appropriately dispose of
25pharmaceuticals collected through the program.
26 Sec. 5. NEW SECTION. 514C.31 Medication-assisted treatment
27coverage.
281. As used in this section:
29a. “Behavioral therapy” means individual, family, or group
30therapy designed to help a patient engage in the treatment
31process, modify the patient’s attitudes and behaviors related
32to substance use, and increase healthy life skills.
33b. “Financial requirements” means deductibles, copayments,
34coinsurance, or out-of-pocket maximums.
35c. “Health care professional” means the same as defined in
-2-1section 135.154.
2d. “Medication-assisted treatment” means the use of
3medications, commonly in combination with counseling and
4behavioral therapies, to provide a comprehensive approach to
5the treatment of substance-related disorders.
6e. “Pharmacologic therapy” means a prescribed course
7of treatment that may include methadone, buprenorphine,
8naloxone, naltrexone, or other federal food and drug
9administration-approved or evidence-based medications for the
10treatment of substance-related disorders.
11f. “Substance-related disorder” means the same as defined
12in section 125.2.
132. Notwithstanding the uniformity of treatment requirements
14of section 514C.6, a policy, contract, or plan providing for
15third-party payment or prepayment of health or medical expenses
16shall provide coverage benefits for medication-assisted
17treatment. Such benefits shall provide coverage for but not be
18limited to pharmacologic therapies and behavioral therapies.
193. Medication-assisted treatment coverage benefits provided
20for under this section shall not be subject to any of the
21following:
22a. Any annual or lifetime dollar limitations.
23b. Limitations to a predesignated facility, specific number
24of visits, days of coverage, days in a waiting period, scope or
25duration of treatment, or other similar limits.
26c. Different financial requirements than for other illnesses
27covered under the policy, contract, or plan.
28d. Step therapy, fail-first, or other similar drug
29utilization strategies or policies for covered persons that may
30conflict with a prescribed course of treatment from a licensed
31health care professional.
324. Requirements for coverage under this section shall not
33be subject to a covered person’s prior successes or failures
34associated with the services provided.
355. The provisions of this section shall apply to all
-3-1third-party payment provider contracts, policies, or plans
2delivered, issued for delivery, continued, or renewed in this
3state on or after July 1, 2017.
46. Any contract provision, written policy, or written
5procedure in violation of this section shall be unenforceable
6and null and void.
7 Sec. 6. MEDICAID MEDICATION-ASSISTED TREATMENT MEDICATIONS
8AND SERVICES. The department of human services shall adopt
9rules pursuant to chapter 17A to require the Iowa Medicaid
10program to cover the medication-assisted treatment medications
11and services provided for under section 514C.31, as enacted
12in this Act, and include those medication-assisted treatment
13medications in its preferred drug lists for the treatment of
14substance-related disorders and prevention of overdose and
15death. The list of medication-assisted treatment medications
16provided for under section 514C.31, as enacted in this Act,
17shall not be deemed to be exclusive, and, as new formulations
18and medications are approved by the federal food and drug
19administration for use in the treatment of substance-related
20disorders, the Iowa Medicaid program shall update its preferred
21drug lists.
22EXPLANATION
23The inclusion of this explanation does not constitute agreement with
24the explanation’s substance by the members of the general assembly.
25This bill makes several changes to the drug prescribing
26and dispensing program maintained by the board of pharmacy in
27accordance with Code chapter 124. The bill requires each board
28created under Code chapter 147 that licenses a prescribing
29practitioner to develop a process to integrate automatic
30registration for the program as part of that board’s licensure
31application and renewal process.
32Currently, the board of pharmacy may enter into an agreement
33with a prescription database or monitoring program operated in
34Kansas or a state bordering Iowa. The bill allows the board
35to enter into such an agreement with a program operated in any
-4-1state.
2The bill allows a pharmacist to dispense a prescription for
3an opioid medication in a lesser quantity than the recommended
4full quantity indicated on the prescription if requested by the
5patient for whom the prescription is written or the patient’s
6legal guardian. If a pharmacist does this, the remaining
7quantity of the prescription shall not be dispensed without a
8new prescription. Also, the pharmacist or an authorized agent
9of the pharmacist shall, as soon as is practicable but not
10more than seven days after the partial dispensing, notify the
11prescriber of the quantity of the opioid medication actually
12dispensed.
13Currently, the board of pharmacy may annually allocate
14not more than $175,000 for administering the pharmaceutical
15collection and disposal program. The bill allows the board
16of pharmacy to allocate an adequate sum for the program every
17year. The bill also allows the board of pharmacy to contract
18with one or more vendors for the provision of supplies and
19services to manage and maintain the program and to safely and
20appropriately dispose of pharmaceuticals collected through the
21program.
22The bill establishes requirements for insurance coverage
23for “medication-assisted treatment”, defined by the bill
24as the use of medications, commonly in combination with
25counseling and behavioral therapies, to provide a comprehensive
26approach to the treatment of substance-related disorders. The
27bill specifies that all policies, contracts, or plans for
28third-party payment of health or medical benefits must provide
29coverage for medication-assisted treatment including but not
30limited to pharmacologic and behavioral therapies. The bill
31nullifies any contract provision, written policy, or written
32procedure in violation of the bill.
33The bill directs the department of human services to
34adopt rules to require the Iowa Medicaid program to cover
35medication-assisted treatment medications and services and
-5-1include those medications in its preferred drug lists for the
2treatment of substance-related disorders and prevention of
3overdose and death.
-6-tr/nh