Read the full stored bill text
Senate
File
209
-
Introduced
SENATE
FILE
209
BY
DONAHUE
,
STAED
,
TOWNSEND
,
CELSI
,
PETERSEN
,
DOTZLER
,
WEINER
,
WINCKLER
,
TRONE
GARRIOTT
,
and
BISIGNANO
A
BILL
FOR
An
Act
relating
to
insurance
coverage
for
prescription
insulin
1
drugs.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
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209
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
twenty-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
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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,
2026:
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,
or
automobile
medical
payment
insurance.
22
5.
The
commissioner
of
insurance
may
adopt
rules
pursuant
to
23
chapter
17A
to
administer
this
section.
24
EXPLANATION
25
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
26
the
explanation’s
substance
by
the
members
of
the
general
assembly.
27
This
bill
relates
to
prescription
insulin
drugs
and
coverage
28
by
policies,
contracts,
or
plans
providing
for
third-party
29
payment
or
prepayment
of
health
or
medical
expenses
that
30
provide
coverage
for
prescription
drugs.
31
The
bill
requires
a
policy,
contract,
or
plan
providing
32
for
third-party
payment
or
prepayment
of
health
or
medical
33
expenses
that
provides
coverage
for
prescription
drugs
to
cap
34
the
total
amount
of
cost-sharing
that
a
covered
person
is
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required
to
pay
per
prescription
filled
of
an
insulin
drug
to
1
an
amount
not
more
than
$25
for
an
up
to
31-day
supply
of
at
2
least
one
type
of
rapid-acting
prescription
insulin
drugs,
3
short-acting
prescription
insulin
drugs,
intermediate-acting
4
prescription
insulin
drugs,
or
long-acting
prescription
insulin
5
drugs.
“Prescription
insulin
drug”
is
defined
in
the
bill
as
6
a
prescription
drug
that
contains
insulin,
is
used
to
treat
7
diabetes,
has
been
prescribed
as
medically
necessary
by
a
8
covered
person’s
health
care
professional,
and
is
a
benefit
9
covered
by
a
covered
person’s
policy,
contract,
or
plan.
The
10
bill
defines
“cost-sharing”
as
any
coverage
limit,
copayment,
11
coinsurance,
deductible,
or
other
out-of-pocket
expense
imposed
12
on
a
covered
person.
13
The
bill
does
not
prohibit
a
policy,
contract,
or
plan
14
providing
for
third-party
payment
or
prepayment
of
health
or
15
medical
expenses
from
reducing
a
covered
person’s
cost-sharing
16
to
less
than
$25
for
up
to
a
31-day
supply
of
a
prescription
17
insulin
drug.
18
The
bill
applies
to
third-party
payment
provider
contracts,
19
policies,
or
plans
delivered,
issued
for
delivery,
continued,
20
or
renewed
in
this
state
on
or
after
January
1,
2026,
by
the
21
third-party
payment
providers
enumerated
in
the
bill.
22
The
bill
specifies
the
types
of
specialized
health-related
23
insurance
which
are
not
subject
to
the
coverage
requirements
24
of
the
bill.
25
The
commissioner
of
insurance
may
adopt
rules
to
administer
26
the
requirements
of
the
bill.
27
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