Bill
Bill > SF197
IA SF197
A bill for an act relating to insurance coverage for prescription drugs used in the treatment of metastatic cancer and associated conditions.
summary
Introduced
02/04/2025
02/04/2025
In Committee
02/04/2025
02/04/2025
Crossed Over
Passed
Dead
Introduced Session
91st General Assembly
Bill Summary
This bill relates to insurance coverage for prescription drugs used in the treatment of metastatic cancer. The bill requires policies, contracts, or plans providing for third-party payment or prepayment of health or medical expenses that provide coverage for prescription drugs to provide coverage for prescription cancer drugs. “Prescription cancer drug” is defined in the bill as a prescription drug that is used to treat metastatic cancer or associated conditions. “Metastatic cancer” is also defined in the bill. The policy, contract, or plan is required to provide coverage, without imposing a step therapy protocol, for a prescription cancer drug that has been approved by the United States food and drug administration, the use of which is in accordance with medical standards of care for metastatic cancer and associated conditions, and the use of which is supported by peer-reviewed, evidence-based literature. “Associated conditions” is defined in the bill. “Step therapy protocol” is defined in the bill as a protocol or program that establishes a specific sequence in which prescription drugs for a specified medical condition and medically appropriate for a particular covered person are covered under a pharmacy or medical benefit by a health carrier, a health benefit plan, or a utilization review organization, including self-administered drugs and drugs administered by a health care professional. The bill applies to the third-party payment providers enumerated in the bill. The bill specifies the types of specialized health-related insurance which are not subject to the coverage requirements of the bill. The commissioner of insurance may adopt rules to administer the requirements of the bill. The provisions of the bill are applicable to third-party payment provider contracts, policies, or plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2026.
AI Summary
This bill establishes new requirements for insurance coverage of prescription drugs used to treat metastatic cancer and its associated conditions. The bill defines key terms such as "metastatic cancer" (cancer that has spread from its original site to other parts of the body), "prescription cancer drug" (a drug used to treat metastatic cancer or related conditions), and "step therapy protocol" (a specific sequence of prescription drug treatments). The legislation mandates that health insurance policies must provide coverage for prescription cancer drugs without requiring patients to try less expensive treatments first (step therapy), provided the drugs meet three specific criteria: they are in accordance with medical standards of care, supported by peer-reviewed literature, and approved by the FDA. The bill applies to various types of health insurance plans, including individual and group accident and sickness insurance, hospital and medical service contracts, and health maintenance organization contracts, beginning January 1, 2026. However, the requirements do not apply to certain specialized insurance types like dental, vision, or workers' compensation coverage. The bill allows the insurance commissioner to create rules for implementing these new requirements, with the goal of ensuring that patients with metastatic cancer have access to potentially life-saving medications without unnecessary administrative barriers.
Committee Categories
Business and Industry
Sponsors (1)
Last Action
Subcommittee recommends passage. (on 02/11/2025)
Official Document
bill text
bill summary
Loading...
bill summary
Loading...
bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://www.legis.iowa.gov/legislation/BillBook?ga=91&ba=SF197 |
| BillText | https://www.legis.iowa.gov/docs/publications/LGI/91/attachments/SF197.html |
Loading...