Bill Text: IA SF413 | 2023-2024 | 90th General Assembly | Introduced
Bill Title: A bill for an act relating to insurance coverage for prescription drugs used to treat substance use disorders.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced) 2023-02-28 - Subcommittee: Schultz, Bousselot, and Trone Garriott. S.J. 438. [SF413 Detail]
Download: Iowa-2023-SF413-Introduced.html
Senate
File
413
-
Introduced
SENATE
FILE
413
BY
WEINER
A
BILL
FOR
An
Act
relating
to
insurance
coverage
for
prescription
drugs
1
used
to
treat
substance
use
disorders.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
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413
Section
1.
NEW
SECTION
.
514C.36
Prescription
drugs
——
1
substance
use
disorders.
2
1.
As
used
in
this
section,
unless
the
context
otherwise
3
requires:
4
a.
“Covered
person”
means
a
policyholder,
subscriber,
or
5
other
person
participating
in
a
policy,
contract,
or
plan
that
6
provides
for
third-party
payment
or
prepayment
of
health
or
7
medical
expenses
that
provides
coverage
for
prescription
drugs.
8
b.
“Health
care
professional”
means
the
same
as
defined
in
9
section
514J.102.
10
c.
“Health
carrier”
means
the
same
as
defined
in
section
11
514J.102.
12
d.
“Prescription
drug”
means
a
prescription
medication,
13
including
an
injectable
medication,
that
has
been
prescribed
14
as
medically
necessary
by
a
covered
person’s
health
care
15
professional.
16
2.
a.
Notwithstanding
the
uniformity
of
treatment
17
requirements
of
section
514C.6,
a
policy,
contract,
or
plan
18
providing
for
third-party
payment
or
prepayment
of
health
or
19
medical
expenses
that
provides
coverage
for
prescription
drugs
20
shall
provide
coverage
for
all
prescription
drugs
approved
21
by
the
United
States
food
and
drug
administration
to
treat
22
substance
use
disorders.
23
b.
Coverage
required
under
this
section
shall
not
be
less
24
favorable
than
coverage
a
health
carrier
offers
for
general
25
physical
illness.
26
c.
Cost-sharing
imposed
for
coverage
required
under
this
27
section
shall
not
be
less
favorable
than
cost-sharing
a
health
28
carrier
imposes
for
general
physical
illness.
29
3.
a.
This
section
applies
to
the
following
classes
of
30
third-party
payment
provider
contracts,
policies,
or
plans
31
delivered,
issued
for
delivery,
continued,
or
renewed
in
this
32
state
on
or
after
January
1,
2024:
33
(1)
Individual
or
group
accident
and
sickness
insurance
34
providing
coverage
on
an
expense-incurred
basis.
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413
(2)
An
individual
or
group
hospital
or
medical
service
1
contract
issued
pursuant
to
chapter
509,
514,
or
514A.
2
(3)
An
individual
or
group
health
maintenance
organization
3
contract
regulated
under
chapter
514B.
4
(4)
A
plan
established
for
public
employees
pursuant
to
5
chapter
509A.
6
b.
This
section
shall
not
apply
to
accident-only,
specified
7
disease,
short-term
hospital
or
medical,
hospital
confinement
8
indemnity,
credit,
dental,
vision,
Medicare
supplement,
9
long-term
care,
basic
hospital
and
medical-surgical
expense
10
coverage
as
defined
by
the
commissioner
of
insurance,
11
disability
income
insurance
coverage,
coverage
issued
as
a
12
supplement
to
liability
insurance,
workers’
compensation
or
13
similar
insurance,
or
automobile
medical
payment
insurance.
14
4.
The
commissioner
of
insurance
may
adopt
rules
pursuant
to
15
chapter
17A
to
administer
this
section.
16
EXPLANATION
17
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
18
the
explanation’s
substance
by
the
members
of
the
general
assembly.
19
This
bill
relates
to
insurance
coverage
for
prescription
20
drugs
used
to
treat
substance
use
disorders.
21
The
bill
requires
policies,
contracts,
or
plans
providing
22
for
third-party
payment
or
prepayment
of
health
or
medical
23
expenses
that
provide
coverage
for
prescription
drugs
to
24
provide
coverage
for
all
prescription
drugs
approved
by
the
25
United
States
food
and
drug
administration
to
treat
substance
26
use
disorders.
“Prescription
drug”
is
defined
in
the
bill
as
27
prescription
medication,
including
an
injectable
medication,
28
that
has
been
prescribed
as
medically
necessary
by
a
covered
29
person’s
health
care
professional.
30
Coverage
required
under
the
bill
shall
not
be
less
favorable
31
than
coverage
a
health
carrier
offers
for
general
physical
32
illness.
Cost-sharing
imposed
for
coverage
required
under
the
33
bill
shall
not
be
less
favorable
than
cost-sharing
a
health
34
carrier
imposes
for
general
physical
illness.
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413
The
bill
applies
to
the
third-party
payment
providers
1
enumerated
in
the
bill.
The
bill
specifies
the
types
of
2
specialized
health-related
insurance
which
are
not
subject
to
3
the
bill.
4
The
commissioner
of
insurance
may
adopt
rules
to
administer
5
the
bill.
6
The
bill
applies
to
third-party
payment
provider
contracts,
7
policies,
or
plans
delivered,
issued
for
delivery,
continued,
8
or
renewed
in
this
state
on
or
after
January
1,
2024.
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