Bill Text: IA HF626 | 2023-2024 | 90th General Assembly | Enrolled
Bill Title: A bill for an act relating to continuity of care and nonmedical switching by health carriers, health benefit plans, and utilization review organizations, and including applicability provisions. (Formerly HF 96.) Effective date: 07/01/2024. Applicability date: 01/01/2025.
Spectrum: Committee Bill
Status: (Passed) 2024-05-08 - Signed by Governor. H.J. 935. [HF626 Detail]
Download: Iowa-2023-HF626-Enrolled.html
House
File
626
-
Enrolled
House
File
626
AN
ACT
RELATING
TO
CONTINUITY
OF
CARE
AND
NONMEDICAL
SWITCHING
BY
HEALTH
CARRIERS,
HEALTH
BENEFIT
PLANS,
AND
UTILIZATION
REVIEW
ORGANIZATIONS,
AND
INCLUDING
APPLICABILITY
PROVISIONS.
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
Section
1.
NEW
SECTION
.
514F.9
Continuity
of
care
——
nonmedical
switching.
1.
Definitions.
For
the
purpose
of
this
section:
a.
“Commissioner”
means
the
commissioner
of
insurance.
b.
“Cost
sharing”
means
any
coverage
limit,
copayment,
coinsurance,
deductible,
or
other
out-of-pocket
expense
requirement.
c.
“Covered
person”
means
the
same
as
defined
in
section
514J.102.
d.
“Demonstrated
bioavailability”
means
the
same
as
defined
in
section
155A.3.
e.
“Formulary”
means
a
complete
list
of
prescription
drugs
eligible
for
coverage
under
a
health
benefit
plan.
f.
“Generic
name”
means
the
same
as
defined
in
section
155A.3.
g.
“Health
benefit
plan”
means
the
same
as
defined
in
section
514J.102.
House
File
626,
p.
2
h.
“Health
care
professional”
means
the
same
as
defined
in
section
514J.102.
i.
“Health
care
services”
means
the
same
as
defined
in
section
514J.102.
j.
“Health
carrier”
means
an
entity
subject
to
the
insurance
laws
and
regulations
of
this
state,
or
subject
to
the
jurisdiction
of
the
commissioner,
including
an
insurance
company
offering
sickness
and
accident
plans,
a
health
maintenance
organization,
a
nonprofit
health
service
corporation,
a
plan
established
pursuant
to
chapter
509A
for
public
employees,
or
any
other
entity
providing
a
plan
of
health
insurance,
health
care
benefits,
or
health
care
services.
“Health
carrier”
does
not
include
the
department
of
human
services,
or
a
managed
care
organization
acting
pursuant
to
a
contract
with
the
department
of
human
services
to
administer
the
medical
assistance
program
under
chapter
249A
or
the
healthy
and
well
kids
in
Iowa
(hawk-i)
program
under
chapter
514I.
k.
“Interchangeable
biological
product”
means
the
same
as
defined
in
section
155A.3.
l.
“Utilization
review
organization”
means
the
same
as
defined
in
section
514F.7.
2.
Nonmedical
switching.
With
respect
to
a
health
carrier
that
has
entered
into
a
health
benefit
plan
with
a
covered
person
that
covers
prescription
drug
benefits,
all
of
the
following
apply:
a.
A
health
carrier,
health
benefit
plan,
or
utilization
review
organization
shall
not
limit
or
exclude
coverage
of
a
prescription
drug
for
any
covered
person
who
is
medically
stable
on
such
drug
as
determined
by
the
prescribing
health
care
professional,
if
all
of
the
following
apply:
(1)
The
prescription
drug
was
previously
approved
by
the
health
carrier
for
coverage
for
the
covered
person.
(2)
The
covered
person’s
prescribing
health
care
professional
has
prescribed
the
drug
for
the
covered
person’s
medical
condition
within
the
previous
six
months.
(3)
The
covered
person
continues
to
be
an
enrollee
of
the
health
benefit
plan.
b.
Coverage
of
a
covered
person’s
prescription
drug,
as
House
File
626,
p.
3
described
in
paragraph
“a”
,
shall
continue
through
the
last
day
of
the
covered
person’s
eligibility
under
the
health
benefit
plan,
or
through
the
last
day
of
the
health
benefit
plan
year,
whichever
is
earlier.
c.
Prohibited
limitations
and
exclusions
referred
to
in
paragraph
“a”
include
but
are
not
limited
to
the
following:
(1)
Limiting
or
reducing
the
maximum
coverage
of
prescription
drug
benefits.
(2)
Increasing
cost
sharing
for
a
covered
prescription
drug.
(3)
Moving
a
prescription
drug
to
a
more
restrictive
tier
if
the
health
carrier
uses
a
formulary
with
tiers.
(4)
Removing
a
prescription
drug
from
a
formulary,
unless
the
United
States
food
and
drug
administration
has
issued
a
statement
about
the
drug
that
calls
into
question
the
clinical
safety
of
the
drug,
or
the
manufacturer
of
the
drug
has
notified
the
United
States
food
and
drug
administration
of
a
manufacturing
discontinuance
or
potential
discontinuance
of
the
drug
as
required
by
section
506C
of
the
Federal
Food,
Drug,
and
Cosmetic
Act,
as
codified
in
21
U.S.C.
§356c.
d.
This
subsection
shall
not
be
construed
to
prohibit
a
substitution,
a
formulary
change,
or
a
preference
by
a
health
carrier
for
a
prescribed
drug
product
that
has
the
same
generic
name
and
demonstrated
bioavailability,
or
that
is
an
interchangeable
biological
product.
3.
Limitations.
This
section
shall
not
be
construed
to
do
any
of
the
following:
a.
Prevent
a
health
care
professional
from
prescribing
another
drug
covered
by
the
health
carrier
that
the
health
care
professional
deems
medically
necessary
for
the
covered
person.
b.
Prevent
a
health
carrier
from
doing
any
of
the
following:
(1)
Adding
a
prescription
drug
to
its
formulary.
(2)
Removing
a
prescription
drug
from
its
formulary
if
the
drug
manufacturer
has
removed
the
drug
for
sale
in
the
United
States.
4.
Enforcement.
The
commissioner
may
take
any
enforcement
action
under
the
commissioner’s
authority
to
enforce
compliance
with
this
section.
Sec.
2.
APPLICABILITY.
This
Act
applies
to
a
health
benefit
House
File
626,
p.
4
plan
that
is
delivered,
issued
for
delivery,
continued,
or
renewed
in
this
state
on
or
after
January
1,
2025.
______________________________
PAT
GRASSLEY
Speaker
of
the
House
______________________________
AMY
SINCLAIR
President
of
the
Senate
I
hereby
certify
that
this
bill
originated
in
the
House
and
is
known
as
House
File
626,
Ninetieth
General
Assembly.
______________________________
MEGHAN
NELSON
Chief
Clerk
of
the
House
Approved
_______________,
2024
______________________________
KIM
REYNOLDS
Governor
