Bill Text: IA HF680 | 2019-2020 | 88th General Assembly | Amended
Bill Title: A bill for an act relating to prescription drug benefits, pharmacies, pharmacy benefit managers, making penalties applicable, and including applicability provisions. (Formerly HF 573.)
Spectrum: Committee Bill
Status: (Engrossed - Dead) 2019-04-03 - Subcommittee: Costello, Edler, and Mathis. S.J. 848. [HF680 Detail]
Download: Iowa-2019-HF680-Amended.html
House
File
680
-
Reprinted
HOUSE
FILE
680
BY
COMMITTEE
ON
COMMERCE
(SUCCESSOR
TO
HF
573)
(As
Amended
and
Passed
by
the
House
March
28,
2019
)
A
BILL
FOR
An
Act
relating
to
prescription
drug
benefits,
pharmacies,
1
pharmacy
benefit
managers,
making
penalties
applicable,
and
2
including
applicability
provisions.
3
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
4
HF
680
(2)
88
ko/lh/md
H.F.
680
Section
1.
Section
507B.2,
subsection
1,
Code
2019,
is
1
amended
to
read
as
follows:
2
1.
“Person”
shall
mean
any
individual,
corporation,
3
association,
partnership,
reciprocal
exchange,
interinsurer,
4
fraternal
beneficiary
association,
and
any
other
legal
entity
5
engaged
in
the
business
of
insurance,
including
insurance
6
producers
and
adjusters.
“Person”
shall
also
mean
any
7
corporation
operating
under
the
provisions
of
chapter
514
,
8
and
any
benevolent
association
as
defined
and
operated
under
9
chapter
512A
,
and
any
pharmacy
benefit
manager
pursuant
to
10
section
510C.1
.
For
purposes
of
this
chapter
,
corporations
11
operating
under
the
provisions
of
chapter
514
and
chapter
512A
12
shall
be
deemed
to
be
engaged
in
the
business
of
insurance.
13
Sec.
2.
Section
507B.3,
Code
2019,
is
amended
by
adding
the
14
following
new
subsection:
15
NEW
SUBSECTION
.
3.
A
person
who
violates
a
provision
in
16
chapter
510C.1
shall
be
deemed
to
have
committed
an
unfair
17
trade
practice
under
this
chapter.
18
Sec.
3.
NEW
SECTION
.
510C.1
Pharmacy
benefit
managers
——
19
retail
pharmacies.
20
1.
As
used
in
this
section,
unless
the
context
otherwise
21
requires:
22
a.
“Commissioner”
means
the
commissioner
of
insurance
or
the
23
commissioner’s
designee.
24
b.
“Cost
sharing”
means
any
copayment,
coinsurance,
25
deductible,
or
other
out-of-pocket
expense
requirement.
26
c.
“Covered
person”
,
“health
benefit
plan”
,
and
“health
27
carrier”
mean
the
same
as
defined
in
section
514J.102.
28
d.
“Otherwise
qualified
retail
pharmacy”
means
a
retail
29
pharmacy
that
meets
the
requirements
established
by
a
pharmacy
30
service
administrative
organization.
31
e.
“Pharmacy”
and
“prescription
drug”
mean
the
same
as
32
defined
in
section
155A.3.
33
f.
“Pharmacy
benefit
manager”
means
a
person
who,
pursuant
34
to
a
contract
or
other
relationship
with
a
health
carrier,
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either
directly
or
through
an
intermediary,
manages
a
1
prescription
drug
benefit
provided
by
the
health
carrier
and
is
2
certified
pursuant
to
section
510B.2.
3
g.
“Pharmacy
benefit
manager’s
retail
pharmacy
network”
means
4
retail
pharmacies
who
have
contracted
with
a
pharmacy
benefit
5
manager
to
dispense
or
sell
prescription
drugs,
other
than
6
specialty
drugs,
to
covered
persons
of
a
health
carrier.
7
h.
“Prescription
drug
benefit”
means
a
health
benefit
plan
8
providing
for
third-party
payment
or
prepayment
of
prescription
9
drugs.
10
i.
“Retail
pharmacy”
means
a
pharmacy
that
is
open
to
the
11
general
public,
dispenses
prescription
drugs
to
the
general
12
public,
and
makes
face-to-face
consultations
available
13
between
licensed
pharmacists
and
the
general
public
to
whom
14
prescription
drugs
are
dispensed.
15
j.
“Specialty
drug”
means
a
prescription
drug
that
is
16
designated
as
a
specialty
drug
by
a
health
carrier
and
that
has
17
either
of
the
following
characteristics:
18
(1)
The
drug
has
received
an
orphan
drug
designation
by
the
19
United
States
food
and
drug
administration.
20
(2)
The
drug’s
manufacturer
or
the
United
States
food
and
21
drug
administration
restricts
distribution
of
the
drug
to
a
22
limited
number
of
distributors.
23
2.
a.
An
otherwise
qualified
retail
pharmacy
that
requests
24
to
enter
into
a
contract
with
a
pharmacy
benefit
manager
to
25
participate
in
the
pharmacy
benefit
manager’s
retail
pharmacy
26
network
and
that
accepts
the
pharmacy
benefit
manager’s
27
standard
terms,
conditions,
formularies,
and
requirements
28
relating
to
dispensing
fees,
payments,
reimbursement
amounts,
29
and
other
pharmacy
services
shall
be
considered
part
of
the
30
pharmacy
benefit
manager’s
retail
pharmacy
network
for
purposes
31
of
a
covered
person’s
right
to
choose
where
to
obtain
the
32
covered
person’s
prescription
drugs,
other
than
a
specialty
33
drug.
34
b.
It
shall
be
a
violation
of
this
section
for
a
pharmacy
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benefit
manager
to
refuse
to
accept
an
otherwise
qualified
1
retail
pharmacy
that
meets
the
criteria
in
paragraph
“a”
as
a
2
part
of
the
pharmacy
benefit
manager’s
retail
pharmacy
network.
3
It
shall
also
be
a
violation
of
this
section
for
a
health
4
carrier
which
has
contracted
with
the
pharmacy
benefit
manager
5
to
refuse
to
accept
an
otherwise
qualified
retail
pharmacy
that
6
meets
the
criteria
in
paragraph
“a”
as
a
part
of
the
pharmacy
7
benefit
manager’s
retail
pharmacy
network.
8
c.
A
contractual
relationship
entered
into
by
an
otherwise
9
qualified
retail
pharmacy
and
a
pharmacy
benefit
manager
10
establishing
the
otherwise
qualified
retail
pharmacy
as
part
of
11
the
pharmacy
benefit
manager’s
retail
pharmacy
network
shall
be
12
renewed
annually
unless
otherwise
agreed
to
by
the
otherwise
13
qualified
retail
pharmacy,
the
pharmacy
benefit
manager,
and
14
the
health
carrier.
15
d.
If
a
pharmacy
benefit
manager
or
a
health
carrier
16
considers
a
retail
pharmacy
not
to
be
otherwise
qualified,
the
17
pharmacy
benefit
manager
or
the
health
carrier
may
file
an
18
appeal
relating
to
the
retail
pharmacy’s
qualifications
with
19
the
insurance
commissioner.
20
e.
A
pharmacy
benefit
manager
that
enters
into
a
contractual
21
relationship
with
an
otherwise
qualified
retail
pharmacy
22
establishing
the
otherwise
qualified
retail
pharmacy
as
part
23
of
the
pharmacy
benefit
manager’s
retail
pharmacy
network,
and
24
a
health
carrier
whose
prescription
drug
benefit
the
pharmacy
25
benefit
manager
is
managing,
shall
not
do
any
of
the
following:
26
(1)
Require
a
covered
person
to
obtain
any
prescription
27
drug,
other
than
a
specialty
drug,
exclusively
from
a
mail
28
order
pharmacy.
29
(2)
Impose
any
cost
sharing
or
other
condition
on
a
covered
30
person
electing
to
use
the
retail
pharmacy
to
obtain
the
31
covered
person’s
prescription
drug,
other
than
a
specialty
32
drug,
if
the
cost
sharing
or
other
condition
is
not
imposed
33
upon
a
covered
person
electing
to
use
a
mail
order
pharmacy
to
34
obtain
the
same
prescription
drug.
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(3)
Restrict
a
prescription
drug,
other
than
a
specialty
1
drug,
dispensed
by
the
retail
pharmacy
to
a
covered
person
to
a
2
minimum
or
maximum
quantity
limit,
or
impose
any
requirement
3
related
to
refills,
if
the
limitations
or
requirements
are
not
4
also
imposed
on
the
same
prescription
drug
dispensed
by
a
mail
5
order
pharmacy.
6
(4)
Require
a
covered
person
to
pay
in
whole
or
in
part
for
7
any
prescription
drug,
other
than
a
specialty
drug,
dispensed
8
to
the
covered
person
by
the
retail
pharmacy
and
require
the
9
covered
person
to
seek
reimbursement,
if
the
same
requirement
10
is
not
imposed
on
a
covered
person
for
a
prescription
drug
11
dispensed
by
a
mail
order
pharmacy.
12
(5)
Impose
any
administrative
burden,
term,
condition,
13
or
requirement
related
to
a
covered
person
electing
to
use
a
14
retail
pharmacy
that
materially
or
unreasonably
interferes
with
15
the
covered
person’s
right
to
obtain
a
prescription
drug,
other
16
than
a
specialty
drug,
from
the
retail
pharmacy.
17
3.
The
commissioner
may
take
any
action
within
the
18
commissioner’s
authority
to
enforce
compliance
with
this
19
section
and
may
assess
a
pharmacy
benefit
manager
and
a
health
20
carrier
a
fine
of
up
to
ten
thousand
dollars
for
each
violation
21
of
subsection
2.
22
4.
Failure
of
a
pharmacy
benefit
manager
or
of
a
health
23
carrier
to
comply
with
any
provision
of
this
section
shall
be
24
an
unfair
trade
practice
under
section
507B.3,
subsection
3.
25
5.
A
pharmacy
benefit
manager
or
a
health
carrier
may
appeal
26
any
decision
of
the
commissioner
in
accordance
with
chapter
27
17A.
28
6.
A
pharmacy
benefit
manager
shall
reimburse
the
division
29
for
all
costs
associated
with
any
examination,
investigation,
30
review,
or
audit
of
the
pharmacy
benefit
manager,
and
a
health
31
carrier
shall
reimburse
the
division
for
all
costs
associated
32
with
any
examination,
investigation,
review,
or
audit
of
the
33
health
carrier.
34
7.
The
commissioner
may
adopt
rules
pursuant
to
chapter
17A
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to
administer
this
section.
1
Sec.
4.
Section
514C.5,
Code
2019,
is
amended
by
striking
2
the
section
and
inserting
in
lieu
thereof
the
following:
3
514C.5
Prescription
drug
benefits.
4
1.
Notwithstanding
the
uniformity
of
treatment
requirements
5
of
section
514C.6,
a
policy,
contract,
or
plan
providing
for
6
third-party
payment
or
prepayment
of
prescription
drug
benefits
7
shall
not
impose
any
terms,
conditions,
or
requirements
upon
8
a
person
covered
under
the
policy,
contract,
or
plan
for
9
prescription
drugs,
other
than
a
specialty
drug
as
defined
10
in
section
510C.1,
dispensed
by
a
retail
pharmacy
which
are
11
different
from
the
terms,
conditions,
or
requirements
imposed
12
for
prescription
drugs,
other
than
a
specialty
drug
as
defined
13
in
section
510C.1,
dispensed
by
a
mail
order
pharmacy.
14
2.
This
section
applies
to
the
following
classes
of
15
third-party
payment
provider
policies,
contracts,
or
plans
16
delivered,
issued
for
delivery,
continued,
or
renewed
in
this
17
state
on
or
after
January
1,
2020:
18
a.
Individual
or
group
accident
and
sickness
insurance
19
providing
coverage
on
an
expense-incurred
basis.
20
b.
An
individual
or
group
hospital
or
medical
service
21
contract
issued
pursuant
to
chapter
509,
514,
or
514A.
22
c.
An
individual
or
group
health
maintenance
organization
23
contract
regulated
under
chapter
514B.
24
d.
A
plan
established
pursuant
to
chapter
509A
for
public
25
employees.
26
3.
This
section
shall
not
apply
to
accident-only,
27
specified
disease,
short-term
hospital
or
medical,
hospital
28
confinement
indemnity,
credit,
dental,
vision,
Medicare
29
supplement,
long-term
care,
basic
hospital
and
medical-surgical
30
expense
coverage
as
defined
by
the
commissioner,
disability
31
income
insurance
coverage,
coverage
issued
as
a
supplement
32
to
liability
insurance,
workers’
compensation
or
similar
33
insurance,
automobile
medical
payment
insurance,
the
medical
34
assistance
program
pursuant
to
chapter
249A,
the
Iowa
health
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and
wellness
plan
pursuant
to
chapter
249N,
or
the
healthy
and
1
well
kids
in
Iowa
program
pursuant
to
chapter
514I.
2
4.
The
commissioner
of
insurance
may
adopt
rules
pursuant
to
3
chapter
17A
to
administer
this
section.
4
Sec.
5.
APPLICABILITY.
The
following
apply
to
a
health
5
benefit
plan
that
is
delivered,
issued
for
delivery,
continued,
6
or
renewed
in
this
state
on
or
after
January
1,
2020:
7
The
section
of
this
Act
enacting
requirements
for
pharmacy
8
benefit
managers,
retail
pharmacies,
and
participation
in
9
pharmacy
benefit
manager
retail
pharmacy
networks.
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