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Bill > HF658

IA HF658

IA HF658
A bill for an act relating to insurance coverage for prescription insulin drugs.

summary

Introduced
02/28/2025
In Committee
02/28/2025
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 cost-sharing for people with health insurance in Iowa, requiring that insurance policies limit out-of-pocket expenses for prescription insulin drugs to no more than $25 for a 31-day supply. The bill specifically covers at least one type of insulin in each of four categories: rapid-acting, short-acting, intermediate-acting, and long-acting. A "prescription insulin drug" is defined as an insulin-based medication used to treat diabetes, prescribed as medically necessary by a healthcare professional, and covered by the person's insurance plan. The legislation applies to various types of health insurance policies, including individual and group accident and sickness insurance, hospital and medical service contracts, and health maintenance organization contracts, starting January 1, 2026. The bill does not apply to specialized insurance types like dental, vision, or workers' compensation coverage. Importantly, the bill allows insurers to reduce cost-sharing below the $25 limit if they choose, and gives the insurance commissioner authority to create rules for implementing the law. The goal of the bill is to make insulin more affordable and accessible for people with diabetes by limiting their out-of-pocket expenses.

Committee Categories

Business and Industry

Sponsors (16)

Last Action

Introduced, referred to Commerce. H.J. 474. (on 02/28/2025)

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