Bill Text: IA HSB582 | 2019-2020 | 88th General Assembly | Introduced
Bill Title: A bill for an act relating to dispensing fees and copayments for partially dispensed quantities of prescription drugs.
Spectrum: Committee Bill
Status: (N/A - Dead) 2020-02-20 - Committee report, recommending passage. H.J. 320. [HSB582 Detail]
Download: Iowa-2019-HSB582-Introduced.html
House
Study
Bill
582
-
Introduced
HOUSE
FILE
_____
BY
(PROPOSED
COMMITTEE
ON
HUMAN
RESOURCES
BILL
BY
CHAIRPERSON
LUNDGREN)
A
BILL
FOR
An
Act
relating
to
dispensing
fees
and
copayments
for
partially
1
dispensed
quantities
of
prescription
drugs.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
TLSB
5494YC
(5)
88
pf/rh
H.F.
_____
Section
1.
NEW
SECTION
.
155A.38A
Prescriptions
dispensed
1
in
partial
quantities
——
limitation
on
dispensing
fee
and
2
copayments.
3
1.
If
a
person
authorized
pursuant
to
this
chapter
to
4
dispense
prescription
drugs
initially
dispenses
a
partial
5
quantity
of
a
thirty-day
supply
of
a
prescription
drug
and
6
subsequently
dispenses
the
remaining
quantity
as
authorized
by
7
the
prescription
within
thirty
days
of
the
initial
dispensing,
8
all
of
the
following
shall
apply:
9
a.
The
cumulative
dispensing
fee
applicable
to
all
partially
10
dispensed
quantities
of
the
prescription
drug
shall
not
exceed
11
the
established
dispensing
fee
applicable
as
if
the
total
12
quantity
prescribed
had
been
dispensed
at
one
time.
13
b.
The
cumulative
copayment
required
for
all
partially
14
dispensed
quantities
of
the
prescription
drug
shall
not
exceed
15
the
established
copayment
applicable
as
if
the
total
quantity
16
prescribed
had
been
dispensed
at
one
time.
17
2.
This
section
shall
apply
whether
the
partial
dispensing
18
of
a
quantity
authorized
by
a
prescription
is
due
to
a
policy
19
of
the
authorized
dispenser,
a
requirement
of
the
third-party
20
payment
provider
contract
or
policy,
a
supply
deficit,
or
for
21
any
other
reason.
22
Sec.
2.
NEW
SECTION
.
514C.35
Prescriptions
dispensed
23
in
partial
quantities
——
limitation
on
dispensing
fee
and
24
copayments.
25
1.
Third-party
payment
provider
contracts
or
policies
26
delivered,
issued
for
delivery,
continued,
or
renewed
in
this
27
state
on
or
after
January
1,
2021,
that
provide
for
third-party
28
payment
or
prepayment
of
health
or
medical
expenses
shall
29
provide
that
if
a
person
authorized
pursuant
to
chapter
155A
to
30
dispense
initially
dispenses
a
partial
quantity
of
a
thirty-day
31
supply
of
a
prescription
drug
and
subsequently
dispenses
the
32
remaining
quantity
as
authorized
by
the
prescription
within
33
thirty
days
of
the
initial
dispensing,
all
of
the
following
34
shall
apply:
35
-1-
LSB
5494YC
(5)
88
pf/rh
1/
5
H.F.
_____
a.
The
cumulative
dispensing
fee
applicable
to
all
partially
1
dispensed
quantities
of
the
prescription
drug
shall
not
exceed
2
the
established
dispensing
fee
applicable
as
if
the
total
3
quantity
prescribed
had
been
dispensed
at
one
time.
4
b.
The
cumulative
copayment
required
for
all
partially
5
dispensed
quantities
of
the
prescription
drug
shall
not
exceed
6
the
established
copayment
applicable
as
if
the
total
quantity
7
prescribed
had
been
dispensed
at
one
time.
8
2.
This
section
shall
apply
whether
the
partial
dispensing
9
of
a
quantity
authorized
by
a
prescription
is
due
to
a
policy
10
of
the
authorized
dispenser,
a
requirement
of
the
third-party
11
payment
provider
contract
or
policy,
a
supply
deficit,
or
for
12
any
other
reason.
13
3.
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
4.
a.
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
b.
This
section
shall
not
apply
to
the
medical
assistance
35
-2-
LSB
5494YC
(5)
88
pf/rh
2/
5
H.F.
_____
program
pursuant
to
chapter
249A,
including
to
a
managed
care
1
organization
acting
pursuant
to
a
contract
with
the
department
2
of
human
services
to
provide
coverage
to
medical
assistance
3
program
members,
or
to
the
hawk-i
program
pursuant
to
chapter
4
514I.
5
Sec.
3.
MEDICAID
PROGRAM
——
DISPENSING
FEE
AND
COPAYMENTS
6
FOR
PRESCRIPTIONS
DISPENSED
IN
PARTIAL
QUANTITIES.
7
1.
The
department
of
human
services
shall
adopt
rules
8
pursuant
to
chapter
17A
to
require
that
if
a
Medicaid
9
provider,
under
both
fee-for-service
and
managed
care
program
10
administration,
who
is
authorized
to
dispense
prescription
11
drugs
pursuant
to
chapter
155A,
initially
dispenses
a
partial
12
quantity
of
a
thirty-day
supply
of
a
prescription
drug
and
13
subsequently
dispenses
the
remaining
quantity
as
authorized
by
14
the
prescription,
all
of
the
following
shall
apply:
15
a.
The
cumulative
dispensing
fee
applicable
to
all
16
partially
dispensed
quantities
of
the
prescription
drug
shall
17
not
exceed
the
established
dispensing
fee
applicable
as
if
the
18
total
quantity
prescribed
had
been
dispensed
at
one
time.
19
b.
The
cumulative
copayment
required
for
all
partially
20
dispensed
quantities
of
the
prescription
drug
shall
not
exceed
21
the
established
copayment
applicable
as
if
the
total
quantity
22
prescribed
had
been
dispensed
at
one
time.
23
2.
This
section
shall
apply
whether
the
partial
dispensing
24
of
a
quantity
authorized
by
a
prescription
is
due
to
a
policy
25
of
the
authorized
dispenser,
a
requirement
of
a
managed
care
26
organization
or
third-party
payment
provider
contract
or
27
policy,
a
supply
deficit,
or
for
any
other
reason.
28
EXPLANATION
29
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
30
the
explanation’s
substance
by
the
members
of
the
general
assembly.
31
This
bill
relates
to
the
dispensing
of
prescription
drugs
in
32
partial
quantities.
33
The
bill
provides
that
if
a
person
authorized
to
dispense
34
prescription
drugs
under
Code
chapter
155A
initially
dispenses
35
-3-
LSB
5494YC
(5)
88
pf/rh
3/
5
H.F.
_____
a
partial
quantity
of
a
30-day
supply
of
a
prescription
1
drug
and
subsequently
dispenses
the
remaining
quantity
as
2
authorized
by
the
prescription
within
30
days
of
the
initial
3
dispensing,
the
cumulative
dispensing
fee
applicable
to
4
all
partially
dispensed
quantities
of
the
prescription
drug
5
shall
not
exceed
the
established
dispensing
fee
applicable
6
as
if
the
total
quantity
prescribed
had
been
dispensed
at
7
one
time,
and
the
cumulative
copayment
required
for
all
8
partially
dispensed
quantities
of
the
prescription
drug
shall
9
not
exceed
the
established
copayment
applicable
as
if
the
10
total
quantity
prescribed
had
been
dispensed
at
one
time.
11
These
requirements
apply
whether
the
partial
dispensing
of
a
12
quantity
authorized
by
a
prescription
is
due
to
a
policy
of
the
13
authorized
dispenser,
a
requirement
of
the
third-party
payment
14
provider
contract
or
policy,
a
supply
deficit,
or
for
any
other
15
reason.
The
bill
directs
the
department
of
human
services
to
16
adopt
administrative
rules
to
require
Medicaid
providers
to
17
comply
with
these
provisions,
whether
the
partial
dispensing
18
of
the
quantity
authorized
by
the
prescription
is
due
to
a
19
policy
of
the
authorized
dispenser,
a
requirement
of
a
managed
20
care
organization
or
third-party
payment
provider
contract
21
or
policy,
a
supply
deficit,
or
for
any
other
reason.
The
22
requirement
applies
under
both
fee-for-service
and
managed
care
23
program
administration
of
Medicaid.
24
Similarly,
the
bill
provides
that
any
third-party
payment
25
provider
contracts
or
policies
delivered,
issued
for
delivery,
26
continued,
or
renewed
in
this
state
on
or
after
January
1,
27
2021,
that
provide
for
third-party
payment
or
prepayment
28
of
health
or
medical
expenses
shall
provide
that
if
a
29
person
authorized
pursuant
to
Code
chapter
155A
to
dispense
30
initially
dispenses
a
partial
quantity
of
a
30-day
supply
of
31
a
prescription
drug
and
subsequently
dispenses
the
remaining
32
quantity
as
authorized
by
the
prescription
within
30
days
33
of
the
initial
dispensing,
the
cumulative
dispensing
fee
34
applicable
to
all
partially
dispensed
quantities
of
the
35
-4-
LSB
5494YC
(5)
88
pf/rh
4/
5
H.F.
_____
prescription
drug
shall
not
exceed
the
established
dispensing
1
fee
applicable
as
if
the
total
quantity
prescribed
had
been
2
dispensed
at
one
time,
and
the
cumulative
copayment
required
3
for
all
partially
dispensed
quantities
of
the
prescription
drug
4
shall
not
exceed
the
established
copayment
applicable
as
if
5
the
total
quantity
prescribed
had
been
dispensed
at
one
time.
6
The
provision
applies
whether
the
partial
dispensing
of
a
7
quantity
authorized
by
a
prescription
is
due
to
a
policy
of
the
8
authorized
dispenser,
a
requirement
of
the
third-party
payment
9
provider
contract
or
policy,
a
supply
deficit,
or
for
any
other
10
reason.
11
-5-
LSB
5494YC
(5)
88
pf/rh
5/
5
