Bill Text: IA HF626 | 2023-2024 | 90th General Assembly | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: A bill for an act relating to continuity of care and nonmedical switching by health carriers, health benefit plans, and utilization review organizations, and including applicability provisions. (Formerly HF 96.) Effective date: 07/01/2024. Applicability date: 01/01/2025.

Spectrum: Committee Bill

Status: (Passed) 2024-05-08 - Signed by Governor. H.J. 935. [HF626 Detail]

Download: Iowa-2023-HF626-Amended.html

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House File 626 - Reprinted
HOUSE FILE 626
BY COMMITTEE ON COMMERCE
(SUCCESSOR TO HF 96)
(As Amended and Passed by the House March 9, 2023 )
A BILL FOR
An Act relating to continuity of care and nonmedical switching
by health carriers, health benefit plans, and utilization
review organizations, and including applicability
provisions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
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Section 1. NEW SECTION . 514F.9 Continuity of care ——
nonmedical switching.
1. Definitions. For the purpose of this section:
a. “Commissioner” means the commissioner of insurance.
b. “Cost sharing” means any coverage limit, copayment,
coinsurance, deductible, or other out-of-pocket expense
requirement.
c. “Covered person” means the same as defined in section
514J.102.
d. “Demonstrated bioavailability” means the same as defined
in section 155A.3.
e. “Formulary” means a complete list of prescription drugs
eligible for coverage under a health benefit plan.
f. “Generic name” means the same as defined in section
155A.3.
g. “Health benefit plan” means the same as defined in
section 514J.102.
h. “Health care professional” means the same as defined in
section 514J.102.
i. “Health care services” means the same as defined in
section 514J.102.
j. “Health carrier” means an entity subject to the
insurance laws and regulations of this state, or subject
to the jurisdiction of the commissioner, including an
insurance company offering sickness and accident plans, a
health maintenance organization, a nonprofit health service
corporation, a plan established pursuant to chapter 509A
for public employees, or any other entity providing a plan
of health insurance, health care benefits, or health care
services. “Health carrier” does not include the department
of human services, or a managed care organization acting
pursuant to a contract with the department of human services to
administer the medical assistance program under chapter 249A
or the healthy and well kids in Iowa (hawk-i) program under
chapter 514I.
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H.F. 626
k. “Interchangeable biological product” means the same as
defined in section 155A.3.
l. “Utilization review organization” means the same as
defined in section 514F.7.
2. Nonmedical switching. With respect to a health carrier
that has entered into a health benefit plan with a covered
person that covers prescription drug benefits, all of the
following apply:
a. A health carrier, health benefit plan, or utilization
review organization shall not limit or exclude coverage of
a prescription drug for any covered person who is medically
stable on such drug as determined by the prescribing health
care professional, if all of the following apply:
(1) The prescription drug was previously approved by the
health carrier for coverage for the covered person.
(2) The covered person’s prescribing health care
professional has prescribed the drug for the covered person’s
medical condition within the previous six months.
(3) The covered person continues to be an enrollee of the
health benefit plan.
b. Coverage of a covered person’s prescription drug, as
described in paragraph “a” , shall continue through the last day
of the covered person’s eligibility under the health benefit
plan, or through the last day of the health benefit plan year,
whichever is earlier.
c. Prohibited limitations and exclusions referred to in
paragraph “a” include but are not limited to the following:
(1) Limiting or reducing the maximum coverage of
prescription drug benefits.
(2) Increasing cost sharing for a covered prescription
drug.
(3) Moving a prescription drug to a more restrictive tier if
the health carrier uses a formulary with tiers.
(4) Removing a prescription drug from a formulary, unless
the United States food and drug administration has issued a
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H.F. 626
statement about the drug that calls into question the clinical
safety of the drug, or the manufacturer of the drug has
notified the United States food and drug administration of a
manufacturing discontinuance or potential discontinuance of the
drug as required by section 506C of the Federal Food, Drug, and
Cosmetic Act, as codified in 21 U.S.C. §356c.
d. This subsection shall not be construed to prohibit
a substitution, a formulary change, or a preference by a
health carrier for a prescribed drug product that has the same
generic name and demonstrated bioavailability, or that is an
interchangeable biological product.
3. Limitations. This section shall not be construed to do
any of the following:
a. Prevent a health care professional from prescribing
another drug covered by the health carrier that the health care
professional deems medically necessary for the covered person.
b. Prevent a health carrier from doing any of the following:
(1) Adding a prescription drug to its formulary.
(2) Removing a prescription drug from its formulary if the
drug manufacturer has removed the drug for sale in the United
States.
4. Enforcement. The commissioner may take any enforcement
action under the commissioner’s authority to enforce compliance
with this section.
Sec. 2. APPLICABILITY. This Act applies to a health benefit
plan that is delivered, issued for delivery, continued, or
renewed in this state on or after January 1, 2024.
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