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Bill > SF209

IA SF209

A bill for an act relating to insurance coverage for prescription insulin drugs.

summary

Introduced
02/04/2025
In Committee
02/04/2025
Crossed Over
Passed
Dead

Introduced Session

91st General Assembly

Bill Summary

This bill relates to prescription insulin drugs and coverage by policies, contracts, or plans providing for third-party payment or prepayment of health or medical expenses that provide coverage for prescription drugs. The bill requires a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses that provides coverage for prescription drugs to cap the total amount of cost-sharing that a covered person is required to pay per prescription filled of an insulin drug to an amount not more than $25 for an up to 31-day supply of at least one type of rapid-acting prescription insulin drugs, short-acting prescription insulin drugs, intermediate-acting prescription insulin drugs, or long-acting prescription insulin drugs. “Prescription insulin drug” is defined in the bill as a prescription drug that contains insulin, is used to treat diabetes, has been prescribed as medically necessary by a covered person’s health care professional, and is a benefit covered by a covered person’s policy, contract, or plan. The bill defines “cost-sharing” as any coverage limit, copayment, coinsurance, deductible, or other out-of-pocket expense imposed on a covered person. The bill does not prohibit a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses from reducing a covered person’s cost-sharing to less than $25 for up to a 31-day supply of a prescription insulin drug. The bill applies 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, by 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.

AI Summary

This bill establishes a cap on insulin drug costs for individuals with health insurance in Iowa, requiring that insurance policies, contracts, and plans limit the out-of-pocket cost for prescription insulin drugs to no more than $25 for a 31-day supply. The bill specifically covers at least one type of each category of insulin drug (rapid-acting, short-acting, intermediate-acting, and long-acting), and 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. The legislation defines key terms such as "prescription insulin drug" (a drug containing insulin used to treat diabetes and prescribed as medically necessary) and "cost-sharing" (any out-of-pocket expenses like copayments or deductibles). The bill will take effect for insurance plans delivered, issued, or renewed on or after January 1, 2026, and does not apply to specialized insurance types like dental, vision, or workers' compensation plans. The insurance commissioner is authorized to create rules to implement this requirement, and insurers are not prohibited from reducing cost-sharing below the $25 limit.

Committee Categories

Business and Industry

Sponsors (10)

Last Action

Subcommittee: Schultz, Rowley, and Trone Garriott. S.J. 203. (on 02/05/2025)
(1 Companion Bills)

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