Iowa-2023-SF413-Introduced

S.F. 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. 35 -1- LSB 2342XS (3) 90 ko/rn 1/ 3

S.F. 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. 35 -2- LSB 2342XS (3) 90 ko/rn 2/ 3

S.F. 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. 9 -3- LSB 2342XS (3) 90 ko/rn 3/ 3