Bill Text: IA SF2078 | 2015-2016 | 86th General Assembly | Introduced
Bill Title: A bill for an act relating to and providing insurance coverage for medication synchronization. (See SF 2261.)
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2016-02-03 - Subcommittee, Sodders, Courtney, and Zumbach. S.J. 152. [SF2078 Detail]
Download: Iowa-2015-SF2078-Introduced.html
Senate File 2078 - Introduced SENATE FILE BY DANIELSON A BILL FOR 1 An Act relating to and providing insurance coverage for 2 medication synchronization. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: TLSB 5745SS (3) 86 pf/nh PAG LIN 1 1 Section 1. NEW SECTION. 514C.5A Prescription drug 1 2 medication synchronization. 1 3 1. A group policy or contract providing for third=party 1 4 payment or prepayment for prescription drugs shall permit and 1 5 apply a prorated daily cost=sharing rate to prescription drugs 1 6 that are dispensed for less than a thirty=day supply, for 1 7 the purposes of synchronizing the medications of the person 1 8 covered under the policy or contract, if the prescriber or 1 9 pharmacist determines the prorated filling or refilling of the 1 10 prescription drug to be in the best interest of the person and 1 11 the person requests or agrees to less than a thirty=day supply. 1 12 However, the group policy or contract shall not use payment 1 13 structures incorporating pro rata dispensing fees, and the 1 14 dispensing fee for partially filled or refilled prescriptions 1 15 shall be paid based on the full supply of each prescription 1 16 dispensed, regardless of any prorated copayment paid by the 1 17 covered person for synchronization of medications. 1 18 2. A group policy or contract providing for third=party 1 19 payment or prepayment for prescription drugs shall not deny 1 20 coverage for the dispensing of multiple prescriptions at one 1 21 time for the purposes of synchronizing medications for a 1 22 covered person under the policy or contract, if the person 1 23 and the pharmacist or other prescriber agree to synchronizing 1 24 the filling or refilling of multiple prescriptions for the 1 25 person. The group policy or contract shall allow a pharmacy 1 26 to override any denial codes indicating that a prescription 1 27 drug is being refilled too soon for the purposes of medication 1 28 synchronization. 1 29 3. A person who provides an individual policy or contract 1 30 providing for third=party payment or prepayment of health or 1 31 medical expenses shall make available a coverage provision 1 32 that satisfies the requirements of this section in the same 1 33 manner as such requirements are applicable to a group policy 1 34 or contract under this section. The policy or contract 1 35 shall provide that the individual policyholder may reject the 2 1 coverage provision at the option of the policyholder. 2 2 4. a. This section applies to the following classes of 2 3 third=party payment provider contracts or policies delivered, 2 4 issued for delivery, continued, or renewed in this state on or 2 5 after January 1, 2017: 2 6 (1) Individual or group accident and sickness insurance 2 7 providing coverage on an expense=incurred basis. 2 8 (2) An individual or group hospital or medical service 2 9 contract issued pursuant to chapter 509, 514, or 514A. 2 10 (3) An individual or group health maintenance organization 2 11 contract regulated under chapter 514B. 2 12 (4) Any other entity engaged in the business of insurance, 2 13 risk transfer, or risk retention, which is subject to the 2 14 jurisdiction of the commissioner. 2 15 (5) A plan established pursuant to chapter 509A for public 2 16 employees. 2 17 (6) An organized delivery system licensed by the director 2 18 of public health. 2 19 b. This section shall not apply to accident=only, 2 20 specified disease, short=term hospital or medical, hospital 2 21 confinement indemnity, credit, dental, vision, Medicare 2 22 supplement, long=term care, basic hospital and medical=surgical 2 23 expense coverage as defined by the commissioner, disability 2 24 income insurance coverage, coverage issued as a supplement 2 25 to liability insurance, workers' compensation or similar 2 26 insurance, or automobile medical payment insurance. 2 27 EXPLANATION 2 28 The inclusion of this explanation does not constitute agreement with 2 29 the explanation's substance by the members of the general assembly. 2 30 This bill relates to insurance coverage for prescription 2 31 drugs dispensed in a manner to facilitate medication 2 32 synchronization. The bill requires that a group policy or 2 33 contract providing for third=party payment or prepayment for 2 34 prescription drugs apply a prorated daily cost=sharing rate to 2 35 prescription drugs that are dispensed for less than a 30=day 3 1 supply, for the purposes of synchronizing the medications 3 2 of the person covered under the policy or contract, if the 3 3 prescriber or pharmacist determines the prorated filling or 3 4 refilling of the prescription drug to be in the best interest 3 5 of the person and the person requests or agrees to less than 3 6 a 30=day supply. However, the group policy or contract shall 3 7 not use payment structures incorporating pro rata dispensing 3 8 fees, and the dispensing fee for partially filled or refilled 3 9 prescriptions shall be paid based on the full supply of each 3 10 prescription dispensed, regardless of any prorated copayment 3 11 paid by the covered person for synchronization of medications. 3 12 The bill also prohibits a group policy or contract providing 3 13 for third=party payment or prepayment for prescription 3 14 drugs from denying coverage for the dispensing of multiple 3 15 prescriptions at one time for the purposes of synchronizing 3 16 medications for a covered person under the policy or contract, 3 17 if the person and the pharmacist or other prescriber agree 3 18 to synchronizing the filling or refilling of multiple 3 19 prescriptions for the person. The group policy or contract 3 20 is required to allow a pharmacy to override any denial codes 3 21 indicating that a prescription drug is being refilled too soon 3 22 for the purposes of medication synchronization. 3 23 The bill requires a person who provides an individual policy 3 24 or contract providing for third=party payment or prepayment 3 25 of health or medical expenses to make available a coverage 3 26 provision that satisfies the requirements of the bill in the 3 27 same manner as such requirements are applicable to a group 3 28 policy or contract. The policy or contract shall provide that 3 29 the individual policyholder may reject the coverage provision 3 30 at the option of the policyholder. 3 31 The bill specifies the classes of third=party payment 3 32 provider contracts or policies delivered, issued for delivery, 3 33 continued, or renewed in this state on or after January 1, 3 34 2017, to which the bill applies or does not apply. LSB 5745SS (3) 86 pf/nh
