Read the full stored bill text
House
File
605
-
Introduced
HOUSE
FILE
605
BY
KONFRST
,
R.
JOHNSON
,
MADISON
,
BAGNIEWSKI
,
CROKEN
,
KRESSIG
,
ZABNER
,
WILSON
,
BAETH
,
AMOS
JR.
,
KURTH
,
BROWN-POWERS
,
WILBURN
,
B.
MEYER
,
MATSON
,
WICHTENDAHL
,
GOSA
,
JUDGE
,
COOLING
,
EHLERT
,
and
OLSON
A
BILL
FOR
An
Act
relating
to
the
prescribing
and
dispensing
of
1
self-administered
hormonal
contraceptives.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
TLSB
2166YH
(3)
91
lh/ko
H.F.
605
Section
1.
Section
155A.3,
Code
2025,
is
amended
by
adding
1
the
following
new
subsections:
2
NEW
SUBSECTION
.
10A.
“Department”
means
the
department
of
3
health
and
human
services.
4
NEW
SUBSECTION
.
45A.
“Self-administered
hormonal
5
contraceptive”
means
a
self-administered
hormonal
contraceptive
6
that
is
approved
by
the
United
States
food
and
drug
7
administration
to
prevent
pregnancy.
“Self-administered
8
hormonal
contraceptive”
includes
an
oral
hormonal
contraceptive,
9
a
hormonal
vaginal
ring,
and
a
hormonal
contraceptive
patch,
10
but
does
not
include
any
drug
intended
to
induce
an
abortion
as
11
defined
in
section
146.1.
12
NEW
SUBSECTION
.
45B.
“Standing
order”
means
a
preauthorized
13
medication
order
with
specific
instructions
from
the
medical
14
director
of
the
department
to
dispense
a
medication
under
15
clearly
defined
circumstances.
16
Sec.
2.
NEW
SECTION
.
155A.49
Pharmacist
dispensing
of
17
self-administered
hormonal
contraceptives
——
standing
order
——
18
requirements
——
limitations
of
liability.
19
1.
a.
Notwithstanding
any
provision
of
law
to
the
20
contrary,
a
pharmacist
may
dispense
a
self-administered
21
hormonal
contraceptive
to
a
patient
pursuant
to
a
standing
22
order
established
by
the
medical
director
of
the
department
in
23
accordance
with
this
section.
24
b.
In
dispensing
a
self-administered
hormonal
contraceptive
25
to
a
patient
under
this
section,
a
pharmacist
shall
comply
with
26
all
of
the
following:
27
(1)
For
an
initial
dispensing
of
a
self-administered
28
hormonal
contraceptive,
the
pharmacist
may
dispense
up
to
29
a
twelve-month
supply
at
one
time
of
the
self-administered
30
hormonal
contraceptive.
31
(2)
For
any
subsequent
dispensing
of
the
same
32
self-administered
hormonal
contraceptive,
the
pharmacist
33
may
dispense
up
to
a
twelve-month
supply
at
one
time
of
the
34
self-administered
hormonal
contraceptive.
35
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2.
A
pharmacist
who
dispenses
a
self-administered
hormonal
1
contraceptive
in
accordance
with
this
section
shall
not
2
require
any
other
prescription
drug
order
authorized
by
a
3
practitioner
prior
to
dispensing
the
self-administered
hormonal
4
contraceptive
to
a
patient.
5
3.
The
medical
director
of
the
department
may
establish
a
6
standing
order
authorizing
the
dispensing
of
self-administered
7
hormonal
contraceptives
by
a
pharmacist
who
does
all
of
the
8
following:
9
a.
Complies
with
the
standing
order
established
pursuant
to
10
this
section.
11
b.
Retains
a
record
of
each
patient
to
whom
a
12
self-administered
hormonal
contraceptive
is
dispensed
under
13
this
section
and
submits
the
record
to
the
department.
14
4.
The
standing
order
shall
require
a
pharmacist
who
15
dispenses
self-administered
hormonal
contraceptives
under
this
16
section
to
do
all
of
the
following:
17
a.
Complete
a
standardized
training
program
and
continuing
18
education
requirements
approved
by
the
board
in
consultation
19
with
the
board
of
medicine
and
the
department
that
are
related
20
to
prescribing
self-administered
hormonal
contraceptives
and
21
include
education
regarding
all
contraceptive
methods
approved
22
by
the
United
States
food
and
drug
administration.
23
b.
Obtain
a
completed
self-screening
risk
assessment,
24
approved
by
the
department
in
collaboration
with
the
board
25
and
the
board
of
medicine,
from
each
patient,
and
verify
26
the
identity
of
each
patient
prior
to
dispensing
the
27
self-administered
hormonal
contraceptive
to
the
patient.
28
c.
Provide
the
patient
with
all
of
the
following:
29
(1)
Written
information
regarding
all
of
the
following:
30
(a)
The
importance
of
completing
an
appointment
with
the
31
patient’s
primary
care
or
women’s
health
care
practitioner
32
to
obtain
preventative
care,
including
but
not
limited
to
33
recommended
tests
and
screenings.
34
(b)
The
effectiveness
and
availability
of
long-acting
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reversible
contraceptives
as
an
alternative
to
1
self-administered
hormonal
contraceptives.
2
(2)
A
copy
of
the
record
of
the
pharmacist’s
encounter
with
3
the
patient
that
includes
all
of
the
following:
4
(a)
The
patient’s
completed
self-screening
risk
assessment.
5
(b)
A
description
of
the
contraceptive
dispensed,
or
the
6
basis
for
not
dispensing
a
contraceptive.
7
(3)
Patient
counseling
regarding
all
of
the
following:
8
(a)
The
appropriate
administration
and
storage
of
the
9
self-administered
hormonal
contraceptive.
10
(b)
Potential
side
effects
and
risks
of
the
11
self-administered
hormonal
contraceptive.
12
(c)
The
need
for
backup
contraception.
13
(d)
When
to
seek
emergency
medical
attention.
14
(e)
The
risk
of
contracting
a
sexually
transmitted
15
infection
or
disease,
and
ways
to
reduce
such
a
risk.
16
5.
The
standing
order
established
pursuant
to
this
section
17
shall
prohibit
a
pharmacist
who
dispenses
a
self-administered
18
hormonal
contraceptive
under
this
section
from
doing
any
of
the
19
following:
20
a.
Requiring
a
patient
to
schedule
an
appointment
with
21
the
pharmacist
for
the
prescribing
or
dispensing
of
a
22
self-administered
hormonal
contraceptive.
23
b.
Dispensing
a
self-administered
hormonal
contraceptive
to
24
a
patient
if
the
results
of
the
self-screening
risk
assessment
25
completed
by
a
patient
pursuant
to
subsection
4,
paragraph
26
“b”
,
indicate
it
is
unsafe
for
the
pharmacist
to
dispense
the
27
self-administered
hormonal
contraceptive
to
the
patient,
in
28
which
case
the
pharmacist
shall
refer
the
patient
to
a
primary
29
care
or
women’s
health
care
practitioner.
30
6.
A
pharmacist
who
dispenses
a
self-administered
hormonal
31
contraceptive
and
the
medical
director
of
the
department
who
32
establishes
a
standing
order
in
compliance
with
this
section
33
shall
be
immune
from
criminal
and
civil
liability
arising
from
34
any
damages
caused
by
the
dispensing,
administering,
or
use
of
35
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a
self-administered
hormonal
contraceptive
or
the
establishment
1
of
the
standing
order
provided
that
the
pharmacist
acts
2
reasonably
and
in
good
faith.
The
medical
director
of
the
3
department
shall
be
considered
to
be
acting
within
the
scope
4
of
the
medical
director’s
office
and
employment
for
purposes
5
of
chapter
669
in
the
establishment
of
a
standing
order
in
6
compliance
with
this
section.
7
7.
The
department,
in
collaboration
with
the
board
and
8
the
board
of
medicine,
and
in
consideration
of
the
guidelines
9
established
by
the
American
congress
of
obstetricians
and
10
gynecologists,
shall
adopt
rules
pursuant
to
chapter
17A
to
11
administer
this
chapter.
12
Sec.
3.
Section
514C.19,
Code
2025,
is
amended
to
read
as
13
follows:
14
514C.19
Prescription
contraceptive
coverage.
15
1.
Notwithstanding
the
uniformity
of
treatment
requirements
16
of
section
514C.6
,
a
group
policy
,
or
contract
,
or
plan
17
providing
for
third-party
payment
or
prepayment
of
health
or
18
medical
expenses
shall
not
do
either
of
the
following
comply
19
as
follows
:
20
a.
Exclude
Such
policy,
contract,
or
plan
shall
not
21
exclude
or
restrict
benefits
for
prescription
contraceptive
22
drugs
or
prescription
contraceptive
devices
which
prevent
23
conception
and
which
are
approved
by
the
United
States
24
food
and
drug
administration,
or
generic
equivalents
25
approved
as
substitutable
by
the
United
States
food
and
drug
26
administration,
if
such
policy
,
or
contract
,
or
plan
provides
27
benefits
for
other
outpatient
prescription
drugs
or
devices.
28
However,
such
policy,
contract,
or
plan
shall
specifically
29
provide
for
payment
including
reimbursement
for
pharmacist
30
consultations,
for
a
self-administered
hormonal
contraceptive,
31
as
prescribed
by
a
practitioner
as
defined
in
section
32
155A.3,
or
as
prescribed
by
standing
order
and
dispensed
by
a
33
pharmacist
pursuant
to
section
155A.49,
including
payment
for
34
up
to
an
initial
twelve-month
supply
of
a
self-administered
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hormonal
contraceptive
dispensed
at
one
time
and
for
up
to
a
1
twelve-month
supply
of
the
same
self-administered
hormonal
2
contraceptive
subsequently
dispensed
at
one
time.
3
b.
Exclude
Such
policy,
contract,
or
plan
shall
not
exclude
4
or
restrict
benefits
for
outpatient
contraceptive
services
5
which
are
provided
for
the
purpose
of
preventing
conception
if
6
such
policy
,
or
contract
,
or
plan
provides
benefits
for
other
7
outpatient
services
provided
by
a
health
care
professional.
8
2.
A
person
who
provides
a
group
policy
,
or
contract
,
or
9
plan
providing
for
third-party
payment
or
prepayment
of
health
10
or
medical
expenses
which
is
subject
to
subsection
1
shall
not
11
do
any
of
the
following:
12
a.
Deny
to
an
individual
eligibility,
or
continued
13
eligibility,
to
enroll
in
or
to
renew
coverage
under
the
terms
14
of
the
policy
,
or
contract
,
or
plan
because
of
the
individual’s
15
use
or
potential
use
of
such
prescription
contraceptive
drugs
16
or
devices,
or
use
or
potential
use
of
outpatient
contraceptive
17
services.
18
b.
Provide
a
monetary
payment
or
rebate
to
a
covered
19
individual
to
encourage
such
individual
to
accept
less
than
the
20
minimum
benefits
provided
for
under
subsection
1
.
21
c.
Penalize
or
otherwise
reduce
or
limit
the
reimbursement
22
of
a
health
care
professional
because
such
professional
23
prescribes
contraceptive
drugs
or
devices,
or
provides
24
contraceptive
services.
25
d.
Provide
incentives,
monetary
or
otherwise,
to
a
health
26
care
professional
to
induce
such
professional
to
withhold
27
from
a
covered
individual
contraceptive
drugs
or
devices,
or
28
contraceptive
services.
29
3.
This
section
shall
not
be
construed
to
prevent
a
30
third-party
payor
from
including
deductibles,
coinsurance,
or
31
copayments
under
the
policy
,
or
contract,
or
plan
as
follows:
32
a.
A
deductible,
coinsurance,
or
copayment
for
benefits
33
for
prescription
contraceptive
drugs
shall
not
be
greater
than
34
such
deductible,
coinsurance,
or
copayment
for
any
outpatient
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prescription
drug
for
which
coverage
under
the
policy
,
or
1
contract
,
or
plan
is
provided.
2
b.
A
deductible,
coinsurance,
or
copayment
for
benefits
for
3
prescription
contraceptive
devices
shall
not
be
greater
than
4
such
deductible,
coinsurance,
or
copayment
for
any
outpatient
5
prescription
device
for
which
coverage
under
the
policy
,
or
6
contract
,
or
plan
is
provided.
7
c.
A
deductible,
coinsurance,
or
copayment
for
benefits
for
8
outpatient
contraceptive
services
shall
not
be
greater
than
9
such
deductible,
coinsurance,
or
copayment
for
any
outpatient
10
health
care
services
for
which
coverage
under
the
policy
,
or
11
contract
,
or
plan
is
provided.
12
4.
This
section
shall
not
be
construed
to
require
a
13
third-party
payor
under
a
policy
,
or
contract
,
or
plan
14
to
provide
benefits
for
experimental
or
investigational
15
contraceptive
drugs
or
devices,
or
experimental
or
16
investigational
contraceptive
services,
except
to
the
extent
17
that
such
policy
,
or
contract
,
or
plan
provides
coverage
for
18
other
experimental
or
investigational
outpatient
prescription
19
drugs
or
devices,
or
experimental
or
investigational
outpatient
20
health
care
services.
21
5.
This
section
shall
not
be
construed
to
limit
or
otherwise
22
discourage
the
use
of
generic
equivalent
drugs
approved
by
the
23
United
States
food
and
drug
administration,
whenever
available
24
and
appropriate.
This
section
,
when
a
brand
name
drug
is
25
requested
by
a
covered
individual
and
a
suitable
generic
26
equivalent
is
available
and
appropriate,
shall
not
be
construed
27
to
prohibit
a
third-party
payor
from
requiring
the
covered
28
individual
to
pay
a
deductible,
coinsurance,
or
copayment
29
consistent
with
subsection
3
,
in
addition
to
the
difference
of
30
the
cost
of
the
brand
name
drug
less
the
maximum
covered
amount
31
for
a
generic
equivalent.
32
6.
A
person
who
provides
an
individual
policy
,
or
contract
,
33
or
plan
providing
for
third-party
payment
or
prepayment
of
34
health
or
medical
expenses
shall
make
available
a
coverage
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provision
that
satisfies
the
requirements
in
subsections
1
1
through
5
in
the
same
manner
as
such
requirements
are
2
applicable
to
a
group
policy
,
or
contract
,
or
plan
under
those
3
subsections.
The
policy
,
or
contract
,
or
plan
shall
provide
4
that
the
individual
policyholder
may
reject
the
coverage
5
provision
at
the
option
of
the
policyholder.
6
7.
For
the
purposes
of
this
section:
7
a.
“Self-administered
hormonal
contraceptive”
means
a
8
self-administered
hormonal
contraceptive
that
is
approved
9
by
the
United
Sates
food
and
drug
administration
to
prevent
10
pregnancy.
“Self-administered
hormonal
contraceptive”
includes
11
an
oral
hormonal
contraceptive,
a
hormonal
vaginal
ring,
and
12
a
hormonal
contraceptive
patch,
but
does
not
include
any
drug
13
intended
to
induce
an
abortion
as
defined
in
section
146.1.
14
b.
“Standing
order”
means
a
preauthorized
medication
15
order
with
specific
instructions
from
the
medical
director
16
of
the
department
of
health
and
human
services
to
dispense
a
17
medication
under
clearly
defined
circumstances.
18
7.
8.
a.
This
section
applies
to
the
following
classes
of
19
third-party
payment
provider
contracts
,
or
policies
,
or
plans
20
delivered,
issued
for
delivery,
continued,
or
renewed
in
this
21
state
on
or
after
July
1,
2000
January
1,
2026
:
22
(1)
Individual
or
group
accident
and
sickness
insurance
23
providing
coverage
on
an
expense-incurred
basis.
24
(2)
An
individual
or
group
hospital
or
medical
service
25
contract
issued
pursuant
to
chapter
509
,
514
,
or
514A
.
26
(3)
An
individual
or
group
health
maintenance
organization
27
contract
regulated
under
chapter
514B
.
28
(4)
Any
other
entity
engaged
in
the
business
of
insurance,
29
risk
transfer,
or
risk
retention,
which
is
subject
to
the
30
jurisdiction
of
the
commissioner.
31
(5)
A
plan
established
pursuant
to
chapter
509A
for
public
32
employees.
33
b.
This
section
shall
not
apply
to
accident-only,
34
specified
disease,
short-term
hospital
or
medical,
hospital
35
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LSB
2166YH
(3)
91
lh/ko
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10
H.F.
605
confinement
indemnity,
credit,
dental,
vision,
Medicare
1
supplement,
long-term
care,
basic
hospital
and
medical-surgical
2
expense
coverage
as
defined
by
the
commissioner,
disability
3
income
insurance
coverage,
coverage
issued
as
a
supplement
4
to
liability
insurance,
workers’
compensation
or
similar
5
insurance,
or
automobile
medical
payment
insurance.
6
Sec.
4.
MEDICAID
COVERAGE
——
SELF-ADMINISTERED
HORMONAL
7
CONTRACEPTIVES.
Notwithstanding
section
514B.32,
subsection
8
5,
section
505.34,
and
any
other
provision
of
law
to
the
9
contrary,
the
department
of
health
and
human
services
shall,
10
contractually
and
by
administrative
rules
adopted
pursuant
11
to
chapter
17A,
require
under
Medicaid
fee-for-service
12
and
Medicaid
managed
care
administration,
coverage
for
13
a
self-administered
hormonal
contraceptive
as
prescribed
14
by
a
practitioner
as
defined
in
section
155A.3,
or
as
15
prescribed
by
standing
order
and
dispensed
by
a
pharmacist
16
pursuant
to
section
155A.49,
including
payment
for
up
to
17
an
initial
twelve-month
supply
of
the
self-administered
18
hormonal
contraceptive
dispensed
at
one
time
and
for
up
to
a
19
twelve-month
supply
of
the
same
self-administered
hormonal
20
contraceptive
subsequently
dispensed
at
one
time.
21
EXPLANATION
22
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
23
the
explanation’s
substance
by
the
members
of
the
general
assembly.
24
This
bill
relates
to
the
dispensing
of
self-administered
25
hormonal
contraceptives
by
a
pharmacist.
The
bill
26
defines
“self-administered
hormonal
contraceptive”
as
a
27
self-administered
hormonal
contraceptive
that
is
approved
by
28
the
United
States
food
and
drug
administration
to
prevent
29
pregnancy,
including
an
oral
hormonal
contraceptive,
a
hormonal
30
vaginal
ring,
and
a
hormonal
contraceptive
patch,
but
not
31
including
any
drug
intended
to
induce
an
abortion.
32
The
bill
provides
that
notwithstanding
any
provision
of
law
33
to
the
contrary,
a
pharmacist
may
dispense
a
self-administered
34
hormonal
contraceptive
to
a
patient
pursuant
to
a
standing
35
-8-
LSB
2166YH
(3)
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lh/ko
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10
H.F.
605
order
established
by
the
medical
director
of
the
department
of
1
health
and
human
services
(medical
director).
For
an
initial
2
dispensing,
a
pharmacist
may
dispense
up
to
a
12-month
supply
3
at
one
time
of
the
self-administered
hormonal
contraceptive,
4
and
for
any
subsequent
dispensing
of
the
same
self-administered
5
hormonal
contraceptive,
a
12-month
supply
at
one
time.
6
Additionally,
the
bill
prohibits
a
pharmacist
who
dispenses
7
a
self-administered
hormonal
contraceptive
in
accordance
8
with
the
bill
from
requiring
any
other
prescription
drug
9
order
authorized
by
a
practitioner
prior
to
dispensing
the
10
self-administered
hormonal
contraceptive.
11
The
bill
authorizes
the
medical
director
to
establish
a
12
standing
order
authorizing
the
dispensing
of
self-administered
13
hormonal
contraceptives
by
any
pharmacist
who
complies
with
the
14
standing
order
and
retains
and
submits
the
patient’s
record
to
15
the
department
of
health
and
human
services
(HHS).
16
The
standing
order
includes
requiring
a
pharmacist
who
17
dispenses
a
self-administered
hormonal
contraceptive
under
18
the
bill
to:
complete
a
standardized
training
program
and
19
continuing
education
requirements
related
to
prescribing
the
20
hormonal
contraceptives;
obtain
a
completed
self-screening
risk
21
assessment
from
each
patient
and
verify
the
identity
of
each
22
patient
before
dispensing
the
hormonal
contraceptives;
provide
23
the
patient
with
certain
written
information;
provide
the
24
patient
with
a
copy
of
the
record
of
the
pharmacist’s
encounter
25
with
the
patient;
and
provide
patient
counseling.
26
The
standing
order
would
prohibit
a
pharmacist
who
dispenses
27
hormonal
contraceptives
under
the
bill
from
requiring
a
28
patient
to
schedule
an
appointment
with
the
pharmacist
for
29
the
prescribing
or
dispensing
of
the
hormonal
contraceptive;
30
and
dispensing
the
hormonal
contraceptives
to
a
patient
if
31
the
results
of
the
patient’s
self-screening
risk
assessment
32
indicate
it
is
unsafe
for
the
pharmacist
to
dispense
the
33
hormonal
contraceptives
to
the
patient,
in
which
case
the
34
pharmacist
shall
refer
the
patient
to
a
practitioner.
35
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LSB
2166YH
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10
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605
The
bill
provides
immunity
for
a
pharmacist
who
dispenses
a
1
self-administered
hormonal
contraceptive
and
for
the
medical
2
director
who
establishes
a
standing
order
in
compliance
with
3
the
bill
from
criminal
and
civil
liability
arising
from
any
4
damages
caused
by
the
dispensing,
administering,
or
use
of
a
5
self-administered
hormonal
contraceptive
or
the
establishment
6
of
the
standing
order
provided
the
pharmacist
acts
reasonably
7
and
in
good
faith.
Additionally,
the
medical
director
shall
8
be
considered
to
be
acting
within
the
scope
of
the
medical
9
director’s
office
and
employment
for
purposes
of
Code
chapter
10
669
(Iowa
tort
claims
Act)
in
the
establishment
of
a
standing
11
order
in
compliance
with
the
bill.
12
The
bill
requires
HHS,
in
collaboration
with
the
boards
of
13
pharmacy
and
medicine,
and
in
consideration
of
the
guidelines
14
established
by
the
American
congress
of
obstetricians
and
15
gynecologists,
to
adopt
administrative
rules
to
administer
the
16
bill.
17
The
bill
amends
prescription
contraceptive
coverage
18
provisions
to
require
that
a
group
policy,
contract,
or
plan
19
delivered,
issued
for
delivery,
continued,
or
renewed
in
the
20
state
on
or
after
January
1,
2026,
providing
for
third-party
21
payment
or
prepayment
of
health
or
medical
expenses,
shall
22
specifically
provide
for
payment
of
self-administered
hormonal
23
contraceptives,
prescribed
and
dispensed
as
specified
in
the
24
bill,
including
those
dispensed
at
one
time.
25
The
bill
also
requires
HHS
to
provide
prescription
26
contraceptive
coverage
under
the
Medicaid
program
consistent
27
with
the
coverage
under
private
insurance
as
provided
under
the
28
bill.
29
-10-
LSB
2166YH
(3)
91
lh/ko
10/
10