Bill Text: IA HSB214 | 2019-2020 | 88th General Assembly | Introduced

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Bill Title: A bill for an act relating to the prescribing and dispensing of self-administered hormonal contraceptives.

Spectrum: Committee Bill

Status: (N/A - Dead) 2019-03-06 - Committee report, recommending amendment and passage. H.J. 419. [HSB214 Detail]

Download: Iowa-2019-HSB214-Introduced.html

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House Study Bill 214 - Introduced
SENATE/HOUSE FILE _____
BY (PROPOSED GOVERNOR BILL)
A BILL FOR
An Act relating to the prescribing and dispensing of
self-administered hormonal contraceptives.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
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Section 1. Section 155A.3, Code 2019, is amended by adding
the following new subsections:
NEW SUBSECTION . 10A. “Department” means the department of
public health.
NEW SUBSECTION . 44A. “Self-administered hormonal
contraceptive” means a self-administered hormonal contraceptive
that is approved by the United States food and drug
administration to prevent pregnancy. “Self-administered
hormonal contraceptive” includes an oral hormonal contraceptive,
a hormonal vaginal ring, and a hormonal contraceptive patch,
but does not include any drug intended to induce an abortion as
defined in section 146.1.
NEW SUBSECTION . 44B. “Standing order” means a preauthorized
medication order with specific instructions from the medical
director of the department to dispense a medication under
clearly defined circumstances.
Sec. 2. NEW SECTION . 155A.47 Pharmacist dispensing of
self-administered hormonal contraceptives —— standing order ——
requirements —— limitations of liability.
1. Notwithstanding any provision of law to the contrary, a
pharmacist may dispense, at one time, up to a one-year supply
of a self-administered hormonal contraceptive to a patient
who is at least eighteen years of age, pursuant to a standing
order established by the medical director of the department in
accordance with this section.
2. A pharmacist who dispenses a self-administered hormonal
contraceptive in accordance with this section shall not
require any other prescription drug order authorized by a
practitioner prior to dispensing the self-administered hormonal
contraceptive to a patient.
3. The medical director of the department may establish a
standing order authorizing the dispensing of self-administered
hormonal contraceptives by a pharmacist who does all of the
following:
a. Complies with the standing order established pursuant to
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this section.
b. Retains a record of each patient to whom a
self-administered hormonal contraceptive is dispensed under
this section and submits the record to the department.
4. The standing order shall require a pharmacist who
dispenses self-administered hormonal contraceptives under this
section to do all of the following:
a. Complete a standardized training program and continuing
education requirements approved by the board in consultation
with the department that are related to prescribing
self-administered hormonal contraceptives and include education
regarding all contraceptive methods approved by the United
States food and drug administration.
b. Obtain a completed self-screening risk assessment,
approved by the department in collaboration with the board and
the board of medicine, from each patient prior to dispensing
the self-administered hormonal contraceptive to the patient.
c. Provide the patient with all of the following:
(1) Written information regarding all of the following:
(a) The importance of completing an appointment with the
patient’s primary care or women’s health care practitioner
to obtain preventative care, including but not limited to
recommended tests and screenings.
(b) The effectiveness and availability of long-acting
reversible contraceptives as an alternative to
self-administered hormonal contraceptives.
(2) A copy of the record of the pharmacist’s encounter with
the patient that includes all of the following:
(a) The patient’s completed self-screening risk assessment.
(b) A description of the contraceptive dispensed, or the
basis for not dispensing a contraceptive.
(3) Patient counseling regarding all of the following:
(a) The appropriate administration and storage of the
self-administered hormonal contraceptive.
(b) Potential side effects and risks of the
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self-administered hormonal contraceptive.
(c) The need for backup contraception.
(d) When to seek emergency medical attention.
(e) The risk of contracting a sexually transmitted
infection or disease, and ways to reduce such a risk.
5. The standing order established pursuant to this section
shall prohibit a pharmacist who dispenses a self-administered
hormonal contraceptive under this section from doing any of the
following:
a. Requiring a patient to schedule an appointment with
the pharmacist for the prescribing or dispensing of a
self-administered hormonal contraceptive.
b. Dispensing self-administered hormonal contraceptives to
a patient for more than twenty-four months after the date a
self-administered hormonal contraceptive is initially dispensed
to the patient without the patient’s attestation that the
patient has consulted with a primary care or women’s health
care practitioner during the preceding twenty-four months.
c. Dispensing a self-administered hormonal contraceptive to
a patient if the results of the self-screening risk assessment
completed by a patient pursuant to subsection 4, paragraph
“b” , indicate it is unsafe for the pharmacist to dispense the
self-administered hormonal contraceptive to the patient, in
which case the pharmacist shall refer the patient to a primary
care or women’s health care practitioner.
6. A pharmacist who dispenses a self-administered hormonal
contraceptive and the medical director of the department who
establishes a standing order in compliance with this section
shall be immune from criminal and civil liability arising
from any damages caused by the dispensing, administering,
or use of a self-administered hormonal contraceptive or the
establishment of the standing order. The medical director of
the department shall be considered to be acting within the
scope of the medical director’s office and employment for
purposes of chapter 669 in the establishment of a standing
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order in compliance with this section.
7. The department, in collaboration with the board and
the board of medicine, and in consideration of the guidelines
established by the American congress of obstetricians and
gynecologists, shall adopt rules pursuant to chapter 17A to
administer this chapter.
Sec. 3. Section 514C.19, Code 2019, is amended to read as
follows:
514C.19 Prescription contraceptive coverage.
1. Notwithstanding the uniformity of treatment requirements
of section 514C.6 , a group policy , or contract , or plan
providing for third-party payment or prepayment of health or
medical expenses shall not do either of the following comply
as follows :
a. Exclude Such policy, contract, or plan shall not
exclude or restrict benefits for prescription contraceptive
drugs or prescription contraceptive devices which prevent
conception and which are approved by the United States
food and drug administration, or generic equivalents
approved as substitutable by the United States food and drug
administration, if such policy , or contract , or plan provides
benefits for other outpatient prescription drugs or devices.
However, such policy, contract, or plan shall specifically
provide for payment of a one-year supply of self-administered
hormonal contraceptives, as prescribed by a practitioner as
defined in section 155A.3, or as prescribed by standing order
and dispensed by a pharmacist pursuant to section 155A.47,
including self-administered hormonal contraceptives dispensed
at one time.
b. Exclude Such policy, contract, or plan shall not exclude
or restrict benefits for outpatient contraceptive services
which are provided for the purpose of preventing conception if
such policy , or contract , or plan provides benefits for other
outpatient services provided by a health care professional.
2. A person who provides a group policy , or contract , or
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plan providing for third-party payment or prepayment of health
or medical expenses which is subject to subsection 1 shall not
do any of the following:
a. Deny to an individual eligibility, or continued
eligibility, to enroll in or to renew coverage under the terms
of the policy , or contract , or plan because of the individual’s
use or potential use of such prescription contraceptive drugs
or devices, or use or potential use of outpatient contraceptive
services.
b. Provide a monetary payment or rebate to a covered
individual to encourage such individual to accept less than the
minimum benefits provided for under subsection 1 .
c. Penalize or otherwise reduce or limit the reimbursement
of a health care professional because such professional
prescribes contraceptive drugs or devices, or provides
contraceptive services.
d. Provide incentives, monetary or otherwise, to a health
care professional to induce such professional to withhold
from a covered individual contraceptive drugs or devices, or
contraceptive services.
3. This section shall not be construed to prevent a
third-party payor from including deductibles, coinsurance, or
copayments under the policy , or contract, or plan as follows:
a. A deductible, coinsurance, or copayment for benefits
for prescription contraceptive drugs shall not be greater than
such deductible, coinsurance, or copayment for any outpatient
prescription drug for which coverage under the policy , or
contract , or plan is provided.
b. A deductible, coinsurance, or copayment for benefits for
prescription contraceptive devices shall not be greater than
such deductible, coinsurance, or copayment for any outpatient
prescription device for which coverage under the policy , or
contract , or plan is provided.
c. A deductible, coinsurance, or copayment for benefits for
outpatient contraceptive services shall not be greater than
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such deductible, coinsurance, or copayment for any outpatient
health care services for which coverage under the policy , or
contract , or plan is provided.
4. This section shall not be construed to require a
third-party payor under a policy , or contract , or plan
to provide benefits for experimental or investigational
contraceptive drugs or devices, or experimental or
investigational contraceptive services, except to the extent
that such policy , or contract , or plan provides coverage for
other experimental or investigational outpatient prescription
drugs or devices, or experimental or investigational outpatient
health care services.
5. This section shall not be construed to limit or otherwise
discourage the use of generic equivalent drugs approved by the
United States food and drug administration, whenever available
and appropriate. This section , when a brand name drug is
requested by a covered individual and a suitable generic
equivalent is available and appropriate, shall not be construed
to prohibit a third-party payor from requiring the covered
individual to pay a deductible, coinsurance, or copayment
consistent with subsection 3 , in addition to the difference of
the cost of the brand name drug less the maximum covered amount
for a generic equivalent.
6. A person who provides an individual policy , or contract ,
or plan providing for third-party payment or prepayment of
health or medical expenses shall make available a coverage
provision that satisfies the requirements in subsections
1 through 5 in the same manner as such requirements are
applicable to a group policy , or contract , or plan under those
subsections. The policy , or contract , or plan shall provide
that the individual policyholder may reject the coverage
provision at the option of the policyholder.
7. a. This section applies to the following classes of
third-party payment provider contracts , or policies , or plan
delivered, issued for delivery, continued, or renewed in this
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state on or after July 1, 2000 January 1, 2020 :
(1) Individual or group accident and sickness insurance
providing coverage on an expense-incurred basis.
(2) An individual or group hospital or medical service
contract issued pursuant to chapter 509 , 514 , or 514A .
(3) An individual or group health maintenance organization
contract regulated under chapter 514B .
(4) Any other entity engaged in the business of insurance,
risk transfer, or risk retention, which is subject to the
jurisdiction of the commissioner.
(5) A plan established pursuant to chapter 509A for public
employees.
b. This section shall not apply to accident-only,
specified disease, short-term hospital or medical, hospital
confinement indemnity, credit, dental, vision, Medicare
supplement, long-term care, basic hospital and medical-surgical
expense coverage as defined by the commissioner, disability
income insurance coverage, coverage issued as a supplement
to liability insurance, workers’ compensation or similar
insurance, or automobile medical payment insurance.
8. This section shall not be construed to require a
third-party payor to provide payment to a practitioner for the
dispensing of a self-administered hormonal contraceptive to
replace a self-administered hormonal contraceptive that has
been dispensed to a covered person and that has been misplaced,
stolen, or destroyed. This section shall not be construed to
require a third-party payor to replace covered prescriptions
that are misplaced, stolen, or destroyed.
9. For the purposes of this section:
a. “Self-administered hormonal contraceptive” means a
self-administered hormonal contraceptive that is approved
by the United Sates food and drug administration to prevent
pregnancy. “Self-administered hormonal contraceptive” includes
an oral hormonal contraceptive, a hormonal vaginal ring, and
a hormonal contraceptive patch, but does not include any drug
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intended to induce an abortion as defined in section 146.1.
b. “Standing order” means a preauthorized medication order
with specific instructions from the medical director of the
department of public health to dispense a medication under
clearly defined circumstances.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
This bill relates to the dispensing of self-administered
hormonal contraceptives by a pharmacist. The bill
defines “self-administered hormonal contraceptive” as a
self-administered hormonal contraceptive that is approved by
the United States food and drug administration to prevent
pregnancy, including an oral hormonal contraceptive, a hormonal
vaginal ring, and a hormonal contraceptive patch, but not
including any drug intended to induce an abortion.
The bill provides that notwithstanding any provision of
law to the contrary, a pharmacist may dispense at one time,
up to a one-year supply of a self-administered hormonal
contraceptive to a patient who is at least 18 years of age
pursuant to a standing order established by the medical
director of the department of public health (medical director).
Additionally, the bill prohibits a pharmacist who dispenses
a self-administered hormonal contraceptive in accordance
with the bill from requiring any other prescription drug
order authorized by a practitioner prior to dispensing the
self-administered hormonal contraceptive.
The bill authorizes the medical director to establish a
standing order authorizing the dispensing of self-administered
hormonal contraceptives by any pharmacist who complies with the
standing order and retains and submits the patient’s record to
the department of public health (DPH).
The standing order includes requiring a pharmacist who
dispenses a self-administered hormonal contraceptive under
the bill to: complete a standardized training program and
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continuing education requirements related to prescribing the
hormonal contraceptives; obtain a completed self-screening risk
assessment from each patient before dispensing the hormonal
contraceptives; provide the patient with certain written
information; provide the patient with a copy of the record
of the pharmacist’s encounter with the patient; and provide
patient counseling.
The standing order is to prohibit a pharmacist who dispenses
hormonal contraceptives under the bill from requiring a
patient to schedule an appointment with the pharmacist for
the prescribing or dispensing of the hormonal contraceptives;
dispensing the hormonal contraceptives to a patient for more
than 24 months after the date initially dispensed without the
patient’s attestation that the patient has consulted with a
practitioner during the preceding 24 months; or dispensing the
hormonal contraceptives to a patient if the results of the
patient’s self-screening risk assessment indicate it is unsafe
for the pharmacist to dispense the hormonal contraceptives
to the patient, in which case the pharmacist shall refer the
patient to a practitioner.
The bill provides immunity, for a pharmacist who dispenses a
self-administered hormonal contraceptive and for the medical
director who establishes a standing order in compliance with
the bill, from criminal and civil liability arising from any
damages caused by the dispensing, administering, or use of a
self-administered hormonal contraceptive or the establishment
of the standing order. Additionally, the medical director
shall be considered to be acting within the scope of the
medical director’s office and employment for purposes of Code
chapter 669 (Iowa tort claims Act) in the establishment of a
standing order in compliance with the bill.
The bill requires DPH, in collaboration with the boards of
pharmacy and medicine, and in consideration of the guidelines
established by the American congress of obstetricians and
gynecologists, to adopt administrative rules to administer the
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bill.
The bill amends prescription contraceptive coverage
provisions to require that a group policy, contract, or plan
delivered, issued for delivery, continued, or renewed in the
state on or after January 1, 2020, providing for third-party
payment or prepayment of health or medical expenses, shall
specifically provide for payment of a one-year supply of
self-administered hormonal contraceptives, as prescribed
and dispensed as specified in the bill, including those
dispensed at one time. The bill provides, however, that
the provisions of the bill relating to coverage are not
to be construed to require a third-party payor to provide
payment to a practitioner for dispensing a self-administered
hormonal contraceptive to replace a self-administered
hormonal contraceptive that has been dispensed to a covered
person and that has been misplaced, stolen, or destroyed.
These provisions are also not to be construed to require a
third-party payor to replace covered prescriptions that are
misplaced, stolen, or destroyed.
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