Iowa HSB 582: A bill for an act relating to dispensing fees and copayments for partially dispensed quantities of prescription drugs. (See HF 2499.)

Bill Text

House Study Bill 582 - Introduced
HOUSE FILE _____
BY (PROPOSED COMMITTEE ON
HUMAN RESOURCES BILL BY
CHAIRPERSON LUNDGREN)
A BILL FOR
An Act relating to dispensing fees and copayments for partially1
dispensed quantities of prescription drugs.2
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:3
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H.F. _____
Section 1. NEW SECTION. 155A.38A Prescriptions dispensed1
in partial quantities —— limitation on dispensing fee and2
copayments.3
1. If a person authorized pursuant to this chapter to4
dispense prescription drugs initially dispenses a partial5
quantity of a thirty-day supply of a prescription drug and6
subsequently dispenses the remaining quantity as authorized by7
the prescription within thirty days of the initial dispensing,8
all of the following shall apply:9
a. The cumulative dispensing fee applicable to all partially10
dispensed quantities of the prescription drug shall not exceed11
the established dispensing fee applicable as if the total12
quantity prescribed had been dispensed at one time.13
b. The cumulative copayment required for all partially14
dispensed quantities of the prescription drug shall not exceed15
the established copayment applicable as if the total quantity16
prescribed had been dispensed at one time.17
2. This section shall apply whether the partial dispensing18
of a quantity authorized by a prescription is due to a policy19
of the authorized dispenser, a requirement of the third-party20
payment provider contract or policy, a supply deficit, or for21
any other reason.22
Sec. 2. NEW SECTION. 514C.35 Prescriptions dispensed23
in partial quantities —— limitation on dispensing fee and24
copayments.25
1. Third-party payment provider contracts or policies26
delivered, issued for delivery, continued, or renewed in this27
state on or after January 1, 2021, that provide for third-party28
payment or prepayment of health or medical expenses shall29
provide that if a person authorized pursuant to chapter 155A to30
dispense initially dispenses a partial quantity of a thirty-day31
supply of a prescription drug and subsequently dispenses the32
remaining quantity as authorized by the prescription within33
thirty days of the initial dispensing, all of the following34
shall apply:35
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a. The cumulative dispensing fee applicable to all partially1
dispensed quantities of the prescription drug shall not exceed2
the established dispensing fee applicable as if the total3
quantity prescribed had been dispensed at one time.4
b. The cumulative copayment required for all partially5
dispensed quantities of the prescription drug shall not exceed6
the established copayment applicable as if the total quantity7
prescribed had been dispensed at one time.8
2. This section shall apply whether the partial dispensing9
of a quantity authorized by a prescription is due to a policy10
of the authorized dispenser, a requirement of the third-party11
payment provider contract or policy, a supply deficit, or for12
any other reason.13
3. For the purposes of this section, “third-party payment14
provider contracts or policies” includes:15
a. Individual or group accident and sickness insurance16
providing coverage on an expense-incurred basis.17
b. An individual or group hospital or medical service18
contract issued pursuant to chapter 509, 514, or 514A.19
c. An individual or group health maintenance organization20
contract regulated under chapter 514B.21
d. Any other entity engaged in the business of insurance,22
risk transfer, or risk retention, which is subject to the23
jurisdiction of the commissioner.24
e. A plan established pursuant to chapter 509A for public25
employees.26
4. a. This section shall not apply to accident-only,27
specified disease, short-term hospital or medical, hospital28
confinement indemnity, credit, dental, vision, Medicare29
supplement, long-term care, basic hospital and medical-surgical30
expense coverage as defined by the commissioner, disability31
income insurance coverage, coverage issued as a supplement32
to liability insurance, workers’ compensation or similar33
insurance, or automobile medical payment insurance.34
b. This section shall not apply to the medical assistance35
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program pursuant to chapter 249A, including to a managed care1
organization acting pursuant to a contract with the department2
of human services to provide coverage to medical assistance3
program members, or to the hawk-i program pursuant to chapter4
514I.5
Sec. 3. MEDICAID PROGRAM —— DISPENSING FEE AND COPAYMENTS6
FOR PRESCRIPTIONS DISPENSED IN PARTIAL QUANTITIES.7
1. The department of human services shall adopt rules8
pursuant to chapter 17A to require that if a Medicaid9
provider, under both fee-for-service and managed care program10
administration, who is authorized to dispense prescription11
drugs pursuant to chapter 155A, initially dispenses a partial12
quantity of a thirty-day supply of a prescription d