Bill
Bill > HF405
summary
Introduced
02/13/2025
02/13/2025
In Committee
02/13/2025
02/13/2025
Crossed Over
Passed
Dead
05/03/2026
05/03/2026
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 out-of-pocket costs for insulin prescription drugs in Iowa, requiring health insurance policies to limit cost-sharing to no more than $25 for up to a 31-day supply of at least one type of insulin drug in each of four categories: rapid-acting, short-acting, intermediate-acting, and long-acting. The bill defines key terms such as "prescription insulin drug" as a diabetes treatment drug prescribed as medically necessary, and "cost-sharing" as any out-of-pocket expense like copayments or deductibles. The law will apply 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, starting January 1, 2026. The bill specifically excludes certain specialized insurance types like dental, vision, and workers' compensation insurance from these requirements. Insurers are not prohibited from offering lower cost-sharing amounts than the $25 cap, and the commissioner of insurance is authorized to create rules to implement and enforce the new requirements. This legislation aims to make insulin more affordable for people with diabetes by limiting their monthly out-of-pocket expenses for this critical medication.
Committee Categories
Business and Industry
Sponsors (1)
Last Action
Introduced, referred to Commerce. H.J. 327. (on 02/13/2025)
Official Document
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://www.legis.iowa.gov/legislation/BillBook?ga=91&ba=HF405 |
| BillText | https://www.legis.iowa.gov/docs/publications/LGI/91/attachments/HF405.html |
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