House File 2511 - Introduced
HOUSE FILE 2511
BY JAMES
A BILL FOR
1 An Act relating to prescription refills in emergency situations
2 and insurance coverage for prescription insulin.
3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
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1 Section 1. Section 155A.29, subsection 3, Code 2022, is
2 amended to read as follows:
3 3. a. Prescriptions may be refilled once pursuant to
4 subsection 2 for a period of time reasonably necessary for the
5 pharmacist to secure prescriber authorization.
6 b. Notwithstanding paragraph “a”, a prescription may be
7 refilled pursuant to subsection 2 once in a twelve-month
8 period, and the pharmacist may dispense an amount not to exceed
9 a thirty-day supply, or if the standard unit of dispensing
10 exceeds a thirty-day supply or is unit dosed, an amount not to
11 exceed the standard supply or unit of dispensing.
12 Sec. 2. NEW SECTION. 514C.18A Prescription insulin drugs
13 —— coverage.
14 1. As used in this section, unless the context otherwise
15 requires:
16 a. “Cost-sharing” means any coverage limit, copayment,
17 coinsurance, deductible, or other out-of-pocket expense
18 obligation imposed on a covered person by a policy, contract,
19 or plan providing for third-party payment or prepayment of
20 health or medical expenses.
21 b. “Covered person” means a policyholder, subscriber, or
22 other person participating in a policy, contract, or plan that
23 provides for third-party payment or prepayment of health or
24 medical expenses.
25 c. “Health care professional” means the same as defined in
26 section 514J.102.
27 d. “Prescription insulin drug” means a prescription drug
28 that contains insulin, is used to treat diabetes, that has been
29 prescribed as medically necessary by a covered person’s health
30 care professional, and is a benefit covered by the covered
31 person’s policy, contract, or plan.
32 2. Notwithstanding the uniformity of treatment requirements
33 of section 514C.6, a policy, contract, or plan providing for
34 third-party payment or prepayment of health or medical expenses
35 that provides coverage for prescription drugs shall cap the
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1 total amount of cost-sharing that a covered person is required
2 to pay per prescription filled to an amount not to exceed
3 twenty-five dollars for up to a thirty-one day supply of at
4 least one type of each of the following:
5 a. Rapid-acting prescription insulin drugs.
6 b. Short-acting prescription insulin drugs.
7 c. Intermediate-acting prescription insulin drugs.
8 d. Long-acting prescription insulin drugs.
9 3. Nothing in this section shall be construed to prohibit
10 a policy, contract, or plan providing for third-party payment
11 or prepayment of health or medical expenses from reducing a
12 covered person’s cost-sharing obligation by an amount greater
13 than the amount specified pursuant to subsection 2.
14 4. a. This section shall apply to the following classes
15 of third-party payment provider contracts, policies, or plans
16 delivered, issued for delivery, continued, or renewed in this
17 state on or after January 1, 2023:
18 (1) Individual or group accident and sickness insurance
19 providing coverage on an expense-incurred basis.
20 (2) An individual or group hospital or medical service
21 contract issued pursuant to chapter 509, 514, or 514A.
22 (3) An individual or group health maintenance organization
23 contract regulated under chapter 514B.
24 (4) A plan established for public employees pursuant to
25 chapter 509A.
26 b. This section shall not apply to accident-only, specified
27 disease, short-term hospital or medical, hospital confinement
28 indemnity, credit, dental, vision, Medicare supplement,
29 long-term care, basic hospital and medical-surgical expense
30 coverage as defined by the commissioner of insurance,
31 disability income insurance coverage, coverage issued as a
32 supplement to liability insurance, workers’ compensation or
33 similar insurance, or automobile medical payment insurance.
34 5. The commissioner of insurance may adopt rules pursuant to
35 chapter 17A to administer this section.
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1 EXPLANATION
2 The inclusion of this explanation does not constitute agreement with
3 the explanation’s substance by the members of the general assembly.
4 This bill relates to prescription refills in emergency
5 situations and insurance coverage for prescription insulin
6 drugs.
7 The bill allows a pharmacist to exercise professional
8 judgment and refill a prescription once in a 12-month period
9 and to dispense an amount not to exceed a 30-day supply, or if
10 the standard amount of dispensing exceeds a 30-day supply or
11 is unit dosed, an amount not to exceed the standard supply or
12 limit of dispensing.
13 The bill requires a policy, contract, or plan providing
14 for third-party payment or prepayment of health or medical
15 expenses that provides coverage for prescription drugs to cap
16 the total amount of cost-sharing that a covered person is
17 required to pay per prescription filled to an amount not to
18 exceed $25 for up to a 31-day supply of at least one type of
19 each of rapid-acting prescription insulin drugs, short-acting
20 prescription insulin drugs, intermediate-acting prescription
21 insulin drugs, or long-acting prescription insulin drugs.
22 “Prescription insulin drug” is defined in the bill as a
23 prescription drug that contains insulin, is used to treat
24 diabetes, has been prescribed as medically necessary by a
25 covered person’s health care professional, and is a benefit
26 covered by a covered person’s policy, contract, or plan. The
27 bill defines “cost-sharing” as any coverage limit, copayment,
28 coinsurance, deductible, or other out-of-pocket expense imposed
29 on a covered person. A policy, contract, or plan is not
30 prohibited from providing for third-party payment or prepayment
31 of health or medical expenses from reducing a covered person’s
32 cost-sharing to less than $25 for a 31-day supply of a
33 prescription insulin drug. This section of the bill applies
34 to third-party payment provider contracts, policies, or plans
35 delivered, issued for delivery, continued, or renewed in this
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1 state on or after January 1, 2023, by the third-party payment
2 providers enumerated in the bill. The types of specialized
3 health-related insurance which are not subject to the coverage
4 requirements are specified in the bill. The commissioner of
5 insurance may adopt rules to administer the requirements of
6 this section of the bill.
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