Iowa-2019-HF696-Introduced

H.F. 696 Section 1. MEDICAID PROGRAM —— DISPENSING FEE FOR 1 PRESCRIPTIONS DISPENSED IN PARTIAL QUANTITIES. The department 2 of human services shall adopt rules pursuant to chapter 17A to 3 require that if a Medicaid provider, under both fee-for-service 4 and managed care program administration, who is authorized 5 to dispense prescription drugs pursuant to chapter 155A, 6 initially dispenses a partial quantity of a prescription drug 7 authorized by a prescription, and subsequently dispenses the 8 remaining quantity as authorized by the prescription, the total 9 dispensing fee charged by the provider for that prescription 10 shall not exceed the standard dispensing fee applicable to the 11 same prescription as if the total quantity authorized had been 12 dispensed at one time. This provision shall apply whether the 13 partial dispensing of a quantity authorized by a prescription 14 is due to a policy of the authorized dispenser, a supply 15 deficit, or for any other reason. 16 Sec. 2. NEW SECTION . 155A.38A Prescriptions dispensed in 17 partial quantities —— limitation on dispensing fee. 18 If a person authorized pursuant to this chapter to dispense 19 prescription drugs, initially dispenses a partial quantity 20 of a prescription drug authorized by a prescription, and 21 subsequently dispenses the remaining quantity as authorized 22 by the prescription, the total dispensing fee charged for 23 that prescription shall not exceed the standard dispensing 24 fee applicable to the same prescription as if the total 25 quantity authorized had been dispensed at one time. This 26 provision shall apply whether the partial dispensing of a 27 quantity authorized by a prescription is due to a policy of 28 the authorized dispenser, a supply deficit, or for any other 29 reason. 30 Sec. 3. NEW SECTION . 514C.35 Dispensing fee for 31 prescription dispensed in partial quantity. 32 1. Third-party payment provider contracts or policies 33 delivered, issued for delivery, continued, or renewed in 34 this state on or after January 1, 2020, that provide for 35 -1- LSB 2754HV (1) 88 pf/rh 1/ 3

H.F. 696 third-party payment or prepayment of health or medical expenses 1 shall provide that if a person authorized pursuant to chapter 2 155A to dispense, initially dispenses a partial quantity 3 of a prescription drug authorized by a prescription, and 4 subsequently dispenses the remaining quantity as authorized 5 by a prescription, the total dispensing fee charged for 6 that prescription shall not exceed the standard dispensing 7 fee applicable to the same prescription as if the total 8 quantity authorized had been dispensed at one time. This 9 provision shall apply whether the partial dispensing of a 10 quantity authorized by a prescription is due to a policy of 11 the authorized dispenser, a supply deficit, or for any other 12 reason. 13 2. For the purposes of this section, “third-party payment 14 provider contracts or policies” includes: 15 a. Individual or group accident and sickness insurance 16 providing coverage on an expense-incurred basis. 17 b. An individual or group hospital or medical service 18 contract issued pursuant to chapter 509, 514, or 514A. 19 c. An individual or group health maintenance organization 20 contract regulated under chapter 514B. 21 d. Any other entity engaged in the business of insurance, 22 risk transfer, or risk retention, which is subject to the 23 jurisdiction of the commissioner. 24 e. 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, or automobile medical payment insurance. 34 EXPLANATION 35 -2- LSB 2754HV (1) 88 pf/rh 2/ 3

H.F. 696 The inclusion of this explanation does not constitute agreement with 1 the explanation’s substance by the members of the general assembly. 2 This bill relates to the dispensing fee for partially 3 dispensed prescriptions. 4 The bill requires the department of human services to adopt 5 administrative rules to require that if a Medicaid provider 6 who is authorized to dispense prescription drugs pursuant to 7 Code chapter 155A (pharmacy) initially dispenses a partial 8 quantity of a prescription drug authorized by a prescription, 9 and subsequently dispenses the remaining quantity as authorized 10 by the prescription, the total dispensing fee charged by the 11 provider for that prescription shall not exceed the standard 12 dispensing fee applicable to the same prescription as if the 13 total quantity authorized had been dispensed at one time. 14 The provision applies whether the partial dispensing of a 15 quantity authorized by a prescription is due to a policy 16 of the authorized dispenser, a supply deficit, or for any 17 other reason. The bill also requires this provision for an 18 authorized dispenser under Code chapter 155A (pharmacy) and 19 under third-party payment provider contracts or policies 20 delivered, issued for delivery, continued, or renewed in this 21 state on or after January 1, 2020. 22 -3- LSB 2754HV (1) 88 pf/rh 3/ 3