Bill Text: IA HF691 | 2023-2024 | 90th General Assembly | Introduced

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Bill Title: A bill for an act relating to the prescribing and dispensing of self-administered hormonal contraceptives.

Spectrum: Partisan Bill (Democrat 33-0)

Status: (Introduced - Dead) 2023-04-06 - Introduced, referred to Health and Human Services. H.J. 776. [HF691 Detail]

Download: Iowa-2023-HF691-Introduced.html

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House File 691 - Introduced
HOUSE FILE 691
BY KONFRST , JAMES , STECKMAN ,
CAHILL , LEVIN , NIELSEN ,
KURTH , AMOS JR. , SCHEETZ ,
MADISON , SRINIVAS , WILSON ,
BUCK , CROKEN , BAGNIEWSKI ,
FORBES , BAETH , GAINES ,
ZABNER , GJERDE , JACOBY ,
STAED , KRESSIG , EHLERT ,
ABDUL-SAMAD , B. MEYER ,
OLSON , BROWN-POWERS ,
WESSEL-KROESCHELL ,
SCHOLTEN , WILBURN , MATSON ,
and COOLING
A BILL FOR
An Act relating to the prescribing and dispensing of
self-administered hormonal contraceptives.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
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Section 1. Section 155A.3, Code 2023, is amended by adding
the following new subsections:
NEW SUBSECTION . 10A. “Department” means the department of
health and human services.
NEW SUBSECTION . 45A. “Self-administered hormonal
contraceptive” means a self-administered hormonal contraceptive
that is approved by the United States food and drug
administration to prevent pregnancy. “Self-administered
hormonal contraceptive” includes an oral hormonal contraceptive,
a hormonal vaginal ring, and a hormonal contraceptive patch,
but does not include any drug intended to induce an abortion as
defined in section 146.1.
NEW SUBSECTION . 45B. “Standing order” means a preauthorized
medication order with specific instructions from the medical
director of the department to dispense a medication under
clearly defined circumstances.
Sec. 2. NEW SECTION . 155A.49 Pharmacist dispensing of
self-administered hormonal contraceptives —— standing order ——
requirements —— limitations of liability.
1. a. Notwithstanding any provision of law to the
contrary, a pharmacist may dispense a self-administered
hormonal contraceptive to a patient pursuant to a standing
order established by the medical director of the department in
accordance with this section.
b. In dispensing a self-administered hormonal contraceptive
to a patient under this section, a pharmacist shall comply with
all of the following:
(1) For an initial dispensing of a self-administered
hormonal contraceptive, the pharmacist may dispense up to
a twelve-month supply at one time of the self-administered
hormonal contraceptive.
(2) For any subsequent dispensing of the same
self-administered hormonal contraceptive, the pharmacist
may dispense up to a twelve-month supply at one time of the
self-administered hormonal contraceptive.
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2. A pharmacist who dispenses a self-administered hormonal
contraceptive in accordance with this section shall not
require any other prescription drug order authorized by a
practitioner prior to dispensing the self-administered hormonal
contraceptive to a patient.
3. The medical director of the department may establish a
standing order authorizing the dispensing of self-administered
hormonal contraceptives by a pharmacist who does all of the
following:
a. Complies with the standing order established pursuant to
this section.
b. Retains a record of each patient to whom a
self-administered hormonal contraceptive is dispensed under
this section and submits the record to the department.
4. The standing order shall require a pharmacist who
dispenses self-administered hormonal contraceptives under this
section to do all of the following:
a. Complete a standardized training program and continuing
education requirements approved by the board in consultation
with the board of medicine and the department that are related
to prescribing self-administered hormonal contraceptives and
include education regarding all contraceptive methods approved
by the United States food and drug administration.
b. Obtain a completed self-screening risk assessment,
approved by the department in collaboration with the board
and the board of medicine, from each patient, and verify
the identity of each patient prior to dispensing the
self-administered hormonal contraceptive to the patient.
c. Provide the patient with all of the following:
(1) Written information regarding all of the following:
(a) The importance of completing an appointment with the
patient’s primary care or women’s health care practitioner
to obtain preventative care, including but not limited to
recommended tests and screenings.
(b) The effectiveness and availability of long-acting
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reversible contraceptives as an alternative to
self-administered hormonal contraceptives.
(2) A copy of the record of the pharmacist’s encounter with
the patient that includes all of the following:
(a) The patient’s completed self-screening risk assessment.
(b) A description of the contraceptive dispensed, or the
basis for not dispensing a contraceptive.
(3) Patient counseling regarding all of the following:
(a) The appropriate administration and storage of the
self-administered hormonal contraceptive.
(b) Potential side effects and risks of the
self-administered hormonal contraceptive.
(c) The need for backup contraception.
(d) When to seek emergency medical attention.
(e) The risk of contracting a sexually transmitted
infection or disease, and ways to reduce such a risk.
5. The standing order established pursuant to this section
shall prohibit a pharmacist who dispenses a self-administered
hormonal contraceptive under this section from doing any of the
following:
a. Requiring a patient to schedule an appointment with
the pharmacist for the prescribing or dispensing of a
self-administered hormonal contraceptive.
b. Dispensing a self-administered hormonal contraceptive to
a patient if the results of the self-screening risk assessment
completed by a patient pursuant to subsection 4, paragraph
“b” , indicate it is unsafe for the pharmacist to dispense the
self-administered hormonal contraceptive to the patient, in
which case the pharmacist shall refer the patient to a primary
care or women’s health care practitioner.
6. A pharmacist who dispenses a self-administered hormonal
contraceptive and the medical director of the department who
establishes a standing order in compliance with this section
shall be immune from criminal and civil liability arising from
any damages caused by the dispensing, administering, or use of
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a self-administered hormonal contraceptive or the establishment
of the standing order provided that the pharmacist acts
reasonably and in good faith. The medical director of the
department shall be considered to be acting within the scope
of the medical director’s office and employment for purposes
of chapter 669 in the establishment of a standing order in
compliance with this section.
7. The department, in collaboration with the board and
the board of medicine, and in consideration of the guidelines
established by the American congress of obstetricians and
gynecologists, shall adopt rules pursuant to chapter 17A to
administer this chapter.
Sec. 3. Section 514C.19, Code 2023, is amended to read as
follows:
514C.19 Prescription contraceptive coverage.
1. Notwithstanding the uniformity of treatment requirements
of section 514C.6 , a group policy , or contract , or plan
providing for third-party payment or prepayment of health or
medical expenses shall not do either of the following comply
as follows :
a. Exclude Such policy, contract, or plan shall not
exclude or restrict benefits for prescription contraceptive
drugs or prescription contraceptive devices which prevent
conception and which are approved by the United States
food and drug administration, or generic equivalents
approved as substitutable by the United States food and drug
administration, if such policy , or contract , or plan provides
benefits for other outpatient prescription drugs or devices.
However, such policy, contract, or plan shall specifically
provide for payment including reimbursement for pharmacist
consultations, for a self-administered hormonal contraceptive,
as prescribed by a practitioner as defined in section
155A.3, or as prescribed by standing order and dispensed by a
pharmacist pursuant to section 155A.49, including payment for
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
twelve-month supply of the same self-administered hormonal
contraceptive subsequently dispensed at one time.
b. Exclude Such policy, contract, or plan shall not exclude
or restrict benefits for outpatient contraceptive services
which are provided for the purpose of preventing conception if
such policy , or contract , or plan provides benefits for other
outpatient services provided by a health care professional.
2. A person who provides a group policy , or contract , or
plan providing for third-party payment or prepayment of health
or medical expenses which is subject to subsection 1 shall not
do any of the following:
a. Deny to an individual eligibility, or continued
eligibility, to enroll in or to renew coverage under the terms
of the policy , or contract , or plan because of the individual’s
use or potential use of such prescription contraceptive drugs
or devices, or use or potential use of outpatient contraceptive
services.
b. Provide a monetary payment or rebate to a covered
individual to encourage such individual to accept less than the
minimum benefits provided for under subsection 1 .
c. Penalize or otherwise reduce or limit the reimbursement
of a health care professional because such professional
prescribes contraceptive drugs or devices, or provides
contraceptive services.
d. Provide incentives, monetary or otherwise, to a health
care professional to induce such professional to withhold
from a covered individual contraceptive drugs or devices, or
contraceptive services.
3. This section shall not be construed to prevent a
third-party payor from including deductibles, coinsurance, or
copayments under the policy , or contract, or plan as follows:
a. A deductible, coinsurance, or copayment for benefits
for prescription contraceptive drugs shall not be greater than
such deductible, coinsurance, or copayment for any outpatient
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prescription drug for which coverage under the policy , or
contract , or plan is provided.
b. A deductible, coinsurance, or copayment for benefits for
prescription contraceptive devices shall not be greater than
such deductible, coinsurance, or copayment for any outpatient
prescription device for which coverage under the policy , or
contract , or plan is provided.
c. A deductible, coinsurance, or copayment for benefits for
outpatient contraceptive services shall not be greater than
such deductible, coinsurance, or copayment for any outpatient
health care services for which coverage under the policy , or
contract , or plan is provided.
4. This section shall not be construed to require a
third-party payor under a policy , or contract , or plan
to provide benefits for experimental or investigational
contraceptive drugs or devices, or experimental or
investigational contraceptive services, except to the extent
that such policy , or contract , or plan provides coverage for
other experimental or investigational outpatient prescription
drugs or devices, or experimental or investigational outpatient
health care services.
5. This section shall not be construed to limit or otherwise
discourage the use of generic equivalent drugs approved by the
United States food and drug administration, whenever available
and appropriate. This section , when a brand name drug is
requested by a covered individual and a suitable generic
equivalent is available and appropriate, shall not be construed
to prohibit a third-party payor from requiring the covered
individual to pay a deductible, coinsurance, or copayment
consistent with subsection 3 , in addition to the difference of
the cost of the brand name drug less the maximum covered amount
for a generic equivalent.
6. A person who provides an individual policy , or contract ,
or plan providing for third-party payment or prepayment of
health or medical expenses shall make available a coverage
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provision that satisfies the requirements in subsections
1 through 5 in the same manner as such requirements are
applicable to a group policy , or contract , or plan under those
subsections. The policy , or contract , or plan shall provide
that the individual policyholder may reject the coverage
provision at the option of the policyholder.
7. a. This section applies to the following classes of
third-party payment provider contracts , or policies , or plans
delivered, issued for delivery, continued, or renewed in this
state on or after July 1, 2000 January 1, 2024 :
(1) Individual or group accident and sickness insurance
providing coverage on an expense-incurred basis.
(2) An individual or group hospital or medical service
contract issued pursuant to chapter 509 , 514 , or 514A .
(3) An individual or group health maintenance organization
contract regulated under chapter 514B .
(4) Any other entity engaged in the business of insurance,
risk transfer, or risk retention, which is subject to the
jurisdiction of the commissioner.
(5) A plan established pursuant to chapter 509A for public
employees.
b. This section shall not apply to accident-only,
specified disease, short-term hospital or medical, hospital
confinement indemnity, credit, dental, vision, Medicare
supplement, long-term care, basic hospital and medical-surgical
expense coverage as defined by the commissioner, disability
income insurance coverage, coverage issued as a supplement
to liability insurance, workers’ compensation or similar
insurance, or automobile medical payment insurance.
8. For the purposes of this section:
a. “Self-administered hormonal contraceptive” means a
self-administered hormonal contraceptive that is approved
by the United Sates food and drug administration to prevent
pregnancy. “Self-administered hormonal contraceptive” includes
an oral hormonal contraceptive, a hormonal vaginal ring, and
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a hormonal contraceptive patch, but does not include any drug
intended to induce an abortion as defined in section 146.1.
b. “Standing order” means a preauthorized medication
order with specific instructions from the medical director
of the department of health and human services to dispense a
medication under clearly defined circumstances.
Sec. 4. MEDICAID COVERAGE —— SELF-ADMINISTERED HORMONAL
CONTRACEPTIVES. Notwithstanding section 514B.32, subsection
5, and any other provision of law to the contrary, the
department of health and human services shall, contractually
and by administrative rules adopted pursuant to chapter
17A, require under Medicaid fee-for-service and Medicaid
managed care administration, coverage for a self-administered
hormonal contraceptive as prescribed by a practitioner as
defined in section 155A.3, or as prescribed by standing order
and dispensed by a pharmacist pursuant to section 155A.49,
including payment for up to an initial twelve-month supply
of the self-administered hormonal contraceptive dispensed
at one time and for up to a twelve-month supply of the same
self-administered hormonal contraceptive subsequently dispensed
at one time.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
This bill relates to the dispensing of self-administered
hormonal contraceptives by a pharmacist. The bill
defines “self-administered hormonal contraceptive” as a
self-administered hormonal contraceptive that is approved by
the United States food and drug administration to prevent
pregnancy, including an oral hormonal contraceptive, a hormonal
vaginal ring, and a hormonal contraceptive patch, but not
including any drug intended to induce an abortion.
The bill provides that notwithstanding any provision of law
to the contrary, a pharmacist may dispense a self-administered
hormonal contraceptive to a patient pursuant to a standing
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order established by the medical director of the department of
health and human services (medical director). For an initial
dispensing, a pharmacist may dispense up to a 12-month supply
at one time of the self-administered hormonal contraceptive,
and for any subsequent dispensing of the same self-administered
hormonal contraceptive, a 12-month supply at one time.
Additionally, the bill prohibits a pharmacist who dispenses
a self-administered hormonal contraceptive in accordance
with the bill from requiring any other prescription drug
order authorized by a practitioner prior to dispensing the
self-administered hormonal contraceptive.
The bill authorizes the medical director to establish a
standing order authorizing the dispensing of self-administered
hormonal contraceptives by any pharmacist who complies with the
standing order and retains and submits the patient’s record to
the department of health and human services (HHS).
The standing order includes requiring a pharmacist who
dispenses a self-administered hormonal contraceptive under
the bill to: complete a standardized training program and
continuing education requirements related to prescribing the
hormonal contraceptives; obtain a completed self-screening risk
assessment from each patient and verify the identity of each
patient before dispensing the hormonal contraceptives; provide
the patient with certain written information; provide the
patient with a copy of the record of the pharmacist’s encounter
with the patient; and provide patient counseling.
The standing order would prohibit a pharmacist who dispenses
hormonal contraceptives under the bill from requiring a
patient to schedule an appointment with the pharmacist for
the prescribing or dispensing of the hormonal contraceptive;
and dispensing the hormonal contraceptives to a patient if
the results of the patient’s self-screening risk assessment
indicate it is unsafe for the pharmacist to dispense the
hormonal contraceptives to the patient, in which case the
pharmacist shall refer the patient to a practitioner.
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The bill provides immunity for a pharmacist who dispenses a
self-administered hormonal contraceptive and for the medical
director who establishes a standing order in compliance with
the bill from criminal and civil liability arising from any
damages caused by the dispensing, administering, or use of a
self-administered hormonal contraceptive or the establishment
of the standing order provided the pharmacist acts reasonably
and in good faith. Additionally, the medical director shall
be considered to be acting within the scope of the medical
director’s office and employment for purposes of Code chapter
669 (Iowa tort claims Act) in the establishment of a standing
order in compliance with the bill.
The bill requires HHS, in collaboration with the boards of
pharmacy and medicine, and in consideration of the guidelines
established by the American congress of obstetricians and
gynecologists, to adopt administrative rules to administer the
bill.
The bill amends prescription contraceptive coverage
provisions to require that a group policy, contract, or plan
delivered, issued for delivery, continued, or renewed in the
state on or after January 1, 2024, providing for third-party
payment or prepayment of health or medical expenses, shall
specifically provide for payment of self-administered hormonal
contraceptives, prescribed and dispensed as specified in the
bill, including those dispensed at one time.
The bill also requires HHS to provide prescription
contraceptive coverage under the Medicaid program consistent
with the coverage under private insurance as provided under the
bill.
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