House File 658 - Introduced HOUSE FILE 658 BY JAMES , KONFRST , R. JOHNSON , MADISON , BAGNIEWSKI , CROKEN , KRESSIG , WILSON , BAETH , AMOS JR. , KURTH , BROWN-POWERS , WILBURN , SRINIVAS , B. MEYER , and McBURNEY 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 TLSB 2773YH (3) 91 nls/ko
H.F. 658 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 persons health 18 care professional, and is a benefit covered by the covered 19 persons 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 35 -1- LSB 2773YH (3) 91 nls/ko 1/ 3
H.F. 658 covered persons 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 explanations 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 35 -2- LSB 2773YH (3) 91 nls/ko 2/ 3
H.F. 658 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 persons health care professional, and is a benefit 9 covered by a covered persons 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 persons 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 -3- LSB 2773YH (3) 91 nls/ko 3/ 3