Bill Text: IA HSB89 | 2017-2018 | 87th General Assembly | Introduced

---

Bill Title: A bill for an act relating to controlled substances, including reporting under the drug prescribing and dispensing information program and insurance coverage for abuse-deterrent opioid analgesic drugs, and making penalties applicable.

Spectrum: Committee Bill

Status: (N/A - Dead) 2017-03-01 - Committee report, recommending amendment and passage. H.J. 494. [HSB89 Detail]

Download: Iowa-2017-HSB89-Introduced.html

---

House Study Bill 89 - Introduced
HOUSE FILE _____
BY (PROPOSED COMMITTEE ON
PUBLIC SAFETY BILL BY
CHAIRPERSON BAUDLER)
A BILL FOR
An Act relating to controlled substances, including reporting
under the drug prescribing and dispensing information
program and insurance coverage for abuse-deterrent opioid
analgesic drugs, and making penalties applicable.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
TLSB 2302YC (4) 87
tr/nh

H.F. _____
Section 1. Section 124.552, subsection 1, unnumbered
paragraph 1, Code 2017, is amended to read as follows:
Each licensed pharmacy that dispenses controlled substances
identified pursuant to section 124.554, subsection 1 ,
paragraph “g” , to patients in the state, and each licensed
pharmacy located in the state that dispenses such controlled
substances identified pursuant to section 124.554, subsection
1 , paragraph “g” , to patients inside or outside the state,
unless specifically excepted in this section or by rule, shall
submit the following prescription information to the program
every day :
Sec. 2. NEW SECTION . 514C.31 Opioid analgesic drug products
—— coverage.
1. Definitions. For purposes of this section, unless the
context otherwise requires:
a. “Abuse-deterrent opioid analgesic drug product” means a
brand-name or generic opioid analgesic drug product approved
by the United States food and drug administration with
abuse-deterrence labeling claims that indicate the product
is expected to result in a meaningful reduction in abuse of
opioids.
b. “Carrier” means an entity that provides health benefit
plans in this state.
c. “Health benefit plan” means a policy, certificate, or
contract providing hospital or medical coverage, benefits, or
services rendered by a health care provider.
d. “Opioid analgesic drug product” means a drug product in
the opioid analgesic drug class prescribed to treat moderate
to severe pain or other conditions and includes immediate
release, extended release, and long-acting forms, whether or
not combined with other drug substances to form a single drug
product or dosage form.
2. Coverage required.
a. Notwithstanding the uniformity of treatment requirements
of section 514C.6, a contract, policy, or plan providing for
-1-
LSB 2302YC (4) 87
tr/nh 1/ 4

H.F. _____
third-party payment or prepayment of health or medical expenses
that provides coverage benefits for opioid analgesic drug
products shall provide coverage for an abuse-deterrent opioid
analgesic drug product as a preferred drug on the carrier’s
drug formulary or preferred drug list.
b. Cost-sharing requirements for abuse-deterrent
opioid analgesic drug products shall not exceed the lowest
cost-sharing requirements applied to other covered prescription
drugs on the carrier’s drug formulary or preferred drug list.
3. Prior authorization.
a. A prior authorization or utilization review requirement
shall not require prior use of an opioid analgesic drug product
other than an abuse-deterrent opioid analgesic drug product
as a prerequisite for access to an abuse-deterrent opioid
analgesic drug product.
b. This subsection shall not be construed to prevent
a carrier from requiring prior authorization for an
abuse-deterrent opioid analgesic drug product, provided that
the same prior authorization requirements are applied to all
versions of the same opioid analgesic drug products that are
not abuse-deterrent opioid analgesic drug products.
4. Applicability.
a. This section applies to the following classes of
third-party payment provider contracts or policies delivered,
issued for delivery, continued, or renewed in this state on or
after July 1, 2017:
(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.
-2-
LSB 2302YC (4) 87
tr/nh 2/ 4

H.F. _____
(5) A plan established pursuant to chapter 509A for public
employees.
(6) An organized delivery system licensed by the director
of public health.
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.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
Currently, pharmacies licensed under Code chapter 155A that
dispense controlled substances are required to submit certain
prescription information to the board of pharmacy’s information
program for drug prescribing and dispensing. Board of pharmacy
rules specify that information must be submitted on a weekly
basis. This bill requires the information to be submitted
every day.
According to Code section 124.558, a pharmacist, pharmacy,
prescribing practitioner, or agent of a pharmacist or
prescribing practitioner who knowingly fails to comply with the
bill shall be subject to disciplinary action by the appropriate
professional licensing board.
The bill requires a “carrier”, defined by the bill as a
provider of health benefit plans in this state, to provide
coverage for abuse-deterrent opioid analgesic drug products as
a preferred drug on the carrier’s drug formulary or preferred
drug list. The bill requires cost-sharing requirements for
these products not exceed the lowest cost-sharing requirements
applied to other drugs on the carrier’s formulary or preferred
drug list.
-3-
LSB 2302YC (4) 87
tr/nh 3/ 4

H.F. _____
The bill defines “abuse-deterrent opioid analgesic
drug product” as a brand-name or generic opioid analgesic
drug product approved by the United States food and drug
administration with abuse-deterrence labeling claims that
indicate the product is expected to result in a meaningful
reduction in abuse of opioids.
The bill applies to the following classes of third-party
payment provider contracts or policies delivered, issued for
delivery, continued, or renewed in this state on or after July
1, 2017: individual or group accident and sickness insurance
providing coverage on an expense-incurred basis; an individual
or group hospital or medical service contract issued pursuant
to Code chapter 509, 514, or 514A; an individual or group
health maintenance organization contract regulated under Code
chapter 514B; any other entity engaged in the business of
insurance, risk transfer, or risk retention, which is subject
to the jurisdiction of the insurance commissioner; a plan
established pursuant to Code chapter 509A for public employees;
and an organized delivery system licensed by the director of
public health.
The bill does 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.
-4-
LSB 2302YC (4) 87
tr/nh 4/ 4