Bill Text: IA HF2511 | 2021-2022 | 89th General Assembly | Introduced
Bill Title: A bill for an act relating to prescription refills in emergency situations and insurance coverage for prescription insulin.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2022-02-23 - Introduced, referred to Human Resources. H.J. 352. [HF2511 Detail]
Download: Iowa-2021-HF2511-Introduced.html
House
File
2511
-
Introduced
HOUSE
FILE
2511
BY
JAMES
A
BILL
FOR
An
Act
relating
to
prescription
refills
in
emergency
situations
1
and
insurance
coverage
for
prescription
insulin.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
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Section
1.
Section
155A.29,
subsection
3,
Code
2022,
is
1
amended
to
read
as
follows:
2
3.
a.
Prescriptions
may
be
refilled
once
pursuant
to
3
subsection
2
for
a
period
of
time
reasonably
necessary
for
the
4
pharmacist
to
secure
prescriber
authorization.
5
b.
Notwithstanding
paragraph
“a”
,
a
prescription
may
be
6
refilled
pursuant
to
subsection
2
once
in
a
twelve-month
7
period,
and
the
pharmacist
may
dispense
an
amount
not
to
exceed
8
a
thirty-day
supply,
or
if
the
standard
unit
of
dispensing
9
exceeds
a
thirty-day
supply
or
is
unit
dosed,
an
amount
not
to
10
exceed
the
standard
supply
or
unit
of
dispensing.
11
Sec.
2.
NEW
SECTION
.
514C.18A
Prescription
insulin
drugs
12
——
coverage.
13
1.
As
used
in
this
section,
unless
the
context
otherwise
14
requires:
15
a.
“Cost-sharing”
means
any
coverage
limit,
copayment,
16
coinsurance,
deductible,
or
other
out-of-pocket
expense
17
obligation
imposed
on
a
covered
person
by
a
policy,
contract,
18
or
plan
providing
for
third-party
payment
or
prepayment
of
19
health
or
medical
expenses.
20
b.
“Covered
person”
means
a
policyholder,
subscriber,
or
21
other
person
participating
in
a
policy,
contract,
or
plan
that
22
provides
for
third-party
payment
or
prepayment
of
health
or
23
medical
expenses.
24
c.
“Health
care
professional”
means
the
same
as
defined
in
25
section
514J.102.
26
d.
“Prescription
insulin
drug”
means
a
prescription
drug
27
that
contains
insulin,
is
used
to
treat
diabetes,
that
has
been
28
prescribed
as
medically
necessary
by
a
covered
person’s
health
29
care
professional,
and
is
a
benefit
covered
by
the
covered
30
person’s
policy,
contract,
or
plan.
31
2.
Notwithstanding
the
uniformity
of
treatment
requirements
32
of
section
514C.6,
a
policy,
contract,
or
plan
providing
for
33
third-party
payment
or
prepayment
of
health
or
medical
expenses
34
that
provides
coverage
for
prescription
drugs
shall
cap
the
35
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total
amount
of
cost-sharing
that
a
covered
person
is
required
1
to
pay
per
prescription
filled
to
an
amount
not
to
exceed
2
twenty-five
dollars
for
up
to
a
thirty-one
day
supply
of
at
3
least
one
type
of
each
of
the
following:
4
a.
Rapid-acting
prescription
insulin
drugs.
5
b.
Short-acting
prescription
insulin
drugs.
6
c.
Intermediate-acting
prescription
insulin
drugs.
7
d.
Long-acting
prescription
insulin
drugs.
8
3.
Nothing
in
this
section
shall
be
construed
to
prohibit
9
a
policy,
contract,
or
plan
providing
for
third-party
payment
10
or
prepayment
of
health
or
medical
expenses
from
reducing
a
11
covered
person’s
cost-sharing
obligation
by
an
amount
greater
12
than
the
amount
specified
pursuant
to
subsection
2.
13
4.
a.
This
section
shall
apply
to
the
following
classes
14
of
third-party
payment
provider
contracts,
policies,
or
plans
15
delivered,
issued
for
delivery,
continued,
or
renewed
in
this
16
state
on
or
after
January
1,
2023:
17
(1)
Individual
or
group
accident
and
sickness
insurance
18
providing
coverage
on
an
expense-incurred
basis.
19
(2)
An
individual
or
group
hospital
or
medical
service
20
contract
issued
pursuant
to
chapter
509,
514,
or
514A.
21
(3)
An
individual
or
group
health
maintenance
organization
22
contract
regulated
under
chapter
514B.
23
(4)
A
plan
established
for
public
employees
pursuant
to
24
chapter
509A.
25
b.
This
section
shall
not
apply
to
accident-only,
specified
26
disease,
short-term
hospital
or
medical,
hospital
confinement
27
indemnity,
credit,
dental,
vision,
Medicare
supplement,
28
long-term
care,
basic
hospital
and
medical-surgical
expense
29
coverage
as
defined
by
the
commissioner
of
insurance,
30
disability
income
insurance
coverage,
coverage
issued
as
a
31
supplement
to
liability
insurance,
workers’
compensation
or
32
similar
insurance,
or
automobile
medical
payment
insurance.
33
5.
The
commissioner
of
insurance
may
adopt
rules
pursuant
to
34
chapter
17A
to
administer
this
section.
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EXPLANATION
1
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
2
the
explanation’s
substance
by
the
members
of
the
general
assembly.
3
This
bill
relates
to
prescription
refills
in
emergency
4
situations
and
insurance
coverage
for
prescription
insulin
5
drugs.
6
The
bill
allows
a
pharmacist
to
exercise
professional
7
judgment
and
refill
a
prescription
once
in
a
12-month
period
8
and
to
dispense
an
amount
not
to
exceed
a
30-day
supply,
or
if
9
the
standard
amount
of
dispensing
exceeds
a
30-day
supply
or
10
is
unit
dosed,
an
amount
not
to
exceed
the
standard
supply
or
11
limit
of
dispensing.
12
The
bill
requires
a
policy,
contract,
or
plan
providing
13
for
third-party
payment
or
prepayment
of
health
or
medical
14
expenses
that
provides
coverage
for
prescription
drugs
to
cap
15
the
total
amount
of
cost-sharing
that
a
covered
person
is
16
required
to
pay
per
prescription
filled
to
an
amount
not
to
17
exceed
$25
for
up
to
a
31-day
supply
of
at
least
one
type
of
18
each
of
rapid-acting
prescription
insulin
drugs,
short-acting
19
prescription
insulin
drugs,
intermediate-acting
prescription
20
insulin
drugs,
or
long-acting
prescription
insulin
drugs.
21
“Prescription
insulin
drug”
is
defined
in
the
bill
as
a
22
prescription
drug
that
contains
insulin,
is
used
to
treat
23
diabetes,
has
been
prescribed
as
medically
necessary
by
a
24
covered
person’s
health
care
professional,
and
is
a
benefit
25
covered
by
a
covered
person’s
policy,
contract,
or
plan.
The
26
bill
defines
“cost-sharing”
as
any
coverage
limit,
copayment,
27
coinsurance,
deductible,
or
other
out-of-pocket
expense
imposed
28
on
a
covered
person.
A
policy,
contract,
or
plan
is
not
29
prohibited
from
providing
for
third-party
payment
or
prepayment
30
of
health
or
medical
expenses
from
reducing
a
covered
person’s
31
cost-sharing
to
less
than
$25
for
a
31-day
supply
of
a
32
prescription
insulin
drug.
This
section
of
the
bill
applies
33
to
third-party
payment
provider
contracts,
policies,
or
plans
34
delivered,
issued
for
delivery,
continued,
or
renewed
in
this
35
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state
on
or
after
January
1,
2023,
by
the
third-party
payment
1
providers
enumerated
in
the
bill.
The
types
of
specialized
2
health-related
insurance
which
are
not
subject
to
the
coverage
3
requirements
are
specified
in
the
bill.
The
commissioner
of
4
insurance
may
adopt
rules
to
administer
the
requirements
of
5
this
section
of
the
bill.
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