Iowa-2023-SF2214-Introduced

S.F. 2214 Section 1. NEW SECTION . 514C.18A Prescription insulin drugs 1 —— coverage. 2 1. As used in this section, unless the context otherwise 3 requires: 4 a. “Cost-sharing” means any coverage limit, copayment, 5 coinsurance, deductible, or other out-of-pocket expense 6 obligation imposed on a covered person by a policy, contract, 7 or plan providing for third-party payment or prepayment of 8 health or medical expenses. 9 b. “Covered person” means a policyholder, subscriber, or 10 other person participating in a policy, contract, or plan that 11 provides for third-party payment or prepayment of health or 12 medical expenses. 13 c. “Health care professional” means the same as defined in 14 section 514J.102. 15 d. “Prescription insulin drug” means a prescription drug 16 that contains insulin, is used to treat diabetes, that has been 17 prescribed as medically necessary by a covered person’s health 18 care professional, and is a benefit covered by the covered 19 person’s policy, contract, or plan. 20 2. Notwithstanding the uniformity of treatment requirements 21 of section 514C.6, a policy, contract, or plan providing for 22 third-party payment or prepayment of health or medical expenses 23 that provides coverage for prescription drugs shall cap the 24 total amount of cost-sharing that a covered person is required 25 to pay per prescription filled to an amount not to exceed 26 seventy-five dollars for up to a thirty-one-day supply of at 27 least one type of each of the following: 28 a. Rapid-acting prescription insulin drugs. 29 b. Short-acting prescription insulin drugs. 30 c. Intermediate-acting prescription insulin drugs. 31 d. Long-acting prescription insulin drugs. 32 3. Nothing in this section shall be construed to prohibit 33 a policy, contract, or plan providing for third-party payment 34 or prepayment of health or medical expenses from reducing a 35 -1- LSB 5983XS (2) 90 nls/ko 1/ 3

S.F. 2214 covered person’s cost-sharing obligation by an amount greater 1 than the amount specified pursuant to subsection 2. 2 4. a. This section shall apply to the following classes 3 of third-party payment provider contracts, policies, or plans 4 delivered, issued for delivery, continued, or renewed in this 5 state on or after January 1, 2025: 6 (1) Individual or group accident and sickness insurance 7 providing coverage on an expense-incurred basis. 8 (2) An individual or group hospital or medical service 9 contract issued pursuant to chapter 509, 514, or 514A. 10 (3) An individual or group health maintenance organization 11 contract regulated under chapter 514B. 12 (4) A plan established for public employees pursuant to 13 chapter 509A. 14 b. This section shall not apply to accident-only, specified 15 disease, short-term hospital or medical, hospital confinement 16 indemnity, credit, dental, vision, Medicare supplement, 17 long-term care, basic hospital and medical-surgical expense 18 coverage as defined by the commissioner of insurance, 19 disability income insurance coverage, coverage issued as a 20 supplement to liability insurance, workers’ compensation or 21 similar insurance, high-deductible health plans, or automobile 22 medical payment insurance. 23 5. The commissioner of insurance may adopt rules pursuant to 24 chapter 17A to administer this section. 25 EXPLANATION 26 The inclusion of this explanation does not constitute agreement with 27 the explanation’s substance by the members of the general assembly. 28 This bill relates to prescription insulin drugs and coverage 29 by policies, contracts, or plans providing for third-party 30 payment or prepayment of health or medical expenses that 31 provide coverage for prescription drugs. 32 The bill requires a policy, contract, or plan providing 33 for third-party payment or prepayment of health or medical 34 expenses that provides coverage for prescription drugs to cap 35 -2- LSB 5983XS (2) 90 nls/ko 2/ 3

S.F. 2214 the total amount of cost-sharing that a covered person is 1 required to pay per prescription filled of an insulin drug to 2 an amount not more than $75 for an up to 31-day supply of at 3 least one type of rapid-acting prescription insulin drugs, 4 short-acting prescription insulin drugs, intermediate-acting 5 prescription insulin drugs, or long-acting prescription insulin 6 drugs. “Prescription insulin drug” is defined in the bill as 7 a prescription drug that contains insulin, is used to treat 8 diabetes, has been prescribed as medically necessary by a 9 covered person’s health care professional, and is a benefit 10 covered by a covered person’s policy, contract, or plan. The 11 bill defines “cost-sharing” as any coverage limit, copayment, 12 coinsurance, deductible, or other out-of-pocket expense imposed 13 on a covered person. 14 The bill does not prohibit a policy, contract, or plan 15 providing for third-party payment or prepayment of health or 16 medical expenses from reducing a covered person’s cost-sharing 17 to less than $75 for up to a 31-day supply of a prescription 18 insulin drug. 19 The bill applies to third-party payment provider contracts, 20 policies, or plans delivered, issued for delivery, continued, 21 or renewed in this state on or after January 1, 2025, by the 22 third-party payment providers enumerated in the bill. 23 The bill specifies the types of specialized health-related 24 insurance which are not subject to the coverage requirements 25 of the bill. 26 The commissioner of insurance may adopt rules to administer 27 the bill. 28 -3- LSB 5983XS (2) 90 nls/ko 3/ 3