SF 513 — A bill for an act relating to the prescribing and dispensing of self-administered hormonal contraceptives. (Formerly SF 348.)

Senate File 513 - IntroducedReprinted SENATE FILE 513 BY COMMITTEE ON HUMAN RESOURCES (SUCCESSOR TO SF 348) (As Amended and Passed by the Senate March 27, 2019) A BILL FOR An Act relating to the prescribing and dispensing of self-administered hormonal contraceptives.

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Dispensing a self-administered hormonal contraceptive to a patient if the results of the self-screening risk assessment completed by a patient pursuant to subsection 4, paragraph “b”, indicate it is unsafe for the pharmacist to dispense the self-administered hormonal contraceptive to the patient, in LSBSF 2637SV513 (3)(4) 88 -3- pf/rhpf/rh/mb 3/113/8 S.F.

A pharmacist who dispenses a self-administered hormonal contraceptive and the medical director of the department who establishes a standing order in compliance with this section shall be immune from criminal and civil liability arising from any damages caused by the dispensing, administering, or use of a self-administered hormonal contraceptive or the establishment of the standing orderorder, providingprovided that the pharmacist acts reasonably and in good faith.

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Provide incentives, monetary or otherwise, to a health care professional to induce such professional to withhold from a covered individual contraceptive drugs or devices, or LSBSF 2637SV513 (3)(4) 88 -5- pf/rhpf/rh/mb 5/115/8 S.F.

This section, when a brand name drug is requested by a covered individual and a suitable generic equivalent is available and appropriate, shall not be construed to prohibit a third-party payor from requiring the covered LSBSF 2637SV513 (3)(4) 88 -6- pf/rhpf/rh/mb 6/116/8 S.F.

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 LSBSF 2637SV513 (3)(4) 88 -7- pf/rhpf/rh/mb 7/117/8 S.F.

EXPLANATIONSF LSB513 2637SV(4) (3) 88 -8- pf/rhpf/rh/mb 8/118/8 S.F.

513 The inclusion of this explanation does not constitute agreement with the explanation’s substance by the members of the general assembly.

This bill relates to the dispensing of self-administered hormonal contraceptives by a pharmacist.

The bill defines “self-administered hormonal contraceptive” as a self-administered hormonal contraceptive that is approved by the United States food and drug administration to prevent pregnancy, including an oral hormonal contraceptive, a hormonal vaginal ring, and a hormonal contraceptive patch, but not including any drug intended to induce an abortion.

The bill provides that notwithstanding any provision of law to the contrary, a pharmacist may dispense a self-administered hormonal contraceptive to a patient who is at least 18 years of age pursuant to a standing order established by the medical director of the department of public health (medical director).

The bill provides for an initial dispensing of only up to a three-month supply at one time followed by a subsequent dispensing of up to a 12-month supply at one time of the same self-administered hormonal contraceptive.

Additionally, the bill prohibits a pharmacist who dispenses a self-administered hormonal contraceptive in accordance with the bill from requiring any other prescription drug order authorized by a practitioner prior to dispensing the self-administered hormonal contraceptive.

The bill authorizes the medical director to establish a standing order authorizing the dispensing of self-administered hormonal contraceptives by any pharmacist who complies with the standing order and retains and submits the patient’s record to the department of public health (DPH).

The standing order includes requiring a pharmacist who dispenses a self-administered hormonal contraceptive under the bill to:

complete a standardized training program and continuing education requirements related to prescribing the hormonal contraceptives;

obtain a completed self-screening risk assessment from each patient, verify the identity and age of LSB 2637SV (3) 88 -9- pf/rh 9/11 S.F.

513 each patient, and perform a blood pressure screening on each patient before dispensing the hormonal contraceptives;

provide the patient with certain written information;

provide the patient with a copy of the record of the pharmacist’s encounter with the patient;

and provide patient counseling.

The standing order is to prohibit a pharmacist who dispenses hormonal contraceptives under the bill from requiring a patient to schedule an appointment with the pharmacist for the prescribing or dispensing of the hormonal contraceptives;

dispensing the hormonal contraceptives to a patient for more than 24 months after the date initially dispensed without the patient’s attestation that the patient has consulted with a practitioner during the preceding 24 months;

or dispensing the hormonal contraceptives to a patient if the results of the patient’s self-screening risk assessment indicate it is unsafe for the pharmacist to dispense the hormonal contraceptives to the patient, in which case the pharmacist shall refer the patient to a practitioner.

The bill provides immunity, for a pharmacist who dispenses a self-administered hormonal contraceptive and for the medical director who establishes a standing order in compliance with the bill, from criminal and civil liability arising from any damages caused by the dispensing, administering, or use of a self-administered hormonal contraceptive or the establishment of the standing order, provided the pharmacist acts reasonably and in good faith.

Additionally, the medical director shall be considered to be acting within the scope of the medical director’s office and employment for purposes of Code chapter 669 (Iowa tort claims Act) in the establishment of a standing order in compliance with the bill.

The bill requires DPH, in collaboration with the boards of pharmacy and medicine, and in consideration of the guidelines established by the American congress of obstetricians and gynecologists, to adopt administrative rules to administer the bill.

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513 The bill amends prescription contraceptive coverage provisions to require that a group policy, contract, or plan delivered, issued for delivery, continued, or renewed in the state on or after January 1, 2020, providing for third-party payment or prepayment of health or medical expenses, shall specifically provide for payment of self-administered hormonal contraceptives, as prescribed and dispensed as specified in the bill.

The bill provides, however, that the provisions of the bill relating to coverage are not to be construed to require a third-party payor to provide payment to a practitioner for dispensing a self-administered hormonal contraceptive to replace a self-administered hormonal contraceptive that has been dispensed to a covered person and that has been misplaced, stolen, or destroyed.

These provisions are also not to be construed to require a third-party payor to replace covered prescriptions that are misplaced, stolen, or destroyed.

The bill also requires the Medicaid program to provide coverage for self-administered hormonal contraceptives as prescribed and dispensed under the bill.

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