Iowa Co-pay Choice Coalition

CO-PAY CHOICE LEGISLATION

State regulated insurance carriers in Iowa will provide that at least 25% of individual and group plans
in each service area in the state will offer a pre-deductible, flat dollar co-payment structure to the
entire drug benefit.
The flat-dollar copayment includes all specialty tier medications.
The co-payment must be reasonably graduated and proportionately related in drug formulary tier
levels.
If a carrier offers only one plan in a given insurance level, then that one plan shall comply with the
requirements listed above for the 25% of individual and group plans.
High deductible or catastrophic plans are exempt from these requirements.

FAQ
How will the "co-pay choice" Have any states implemented
model help patients? the "co-pay choice" model?

Patients with debilitating chronic and/or life-threatening

conditions most affected by high cost-sharing for Yes. Colorado and Montana have implemented
drugs including individuals with multiple sclerosis, such models. The insurance departments issued
primary immunodeficiency diseases, auto immune guidance requiring that insurers offer a minimum
diseases, and cancer will be able to select a health number of plans with fixed co-pays, some of which
plan where medicines will be covered immediately- could not have a drug deductible.1
not after meeting a deductible. Also, cost-sharing for
medicines will be fixed and predictable, allowing them Did the "co-pay choice" model raise
to understand and budget for their healthcare costs. premiums in Colorado or Montana?

Can insurers offer plans with

deductibles and co-insurance? No. In Colorado, the larger of the two markets,
premiums between plans that offered fixed copays
and no drug deductible were similar to other
Yes. They will have full control over all benefit plans offered in the marketplace; stakeholders in
design features in all of the other plans they offer. Montana have not noted an impact on premiums.2

WHAT DOES THE BILL DO? WHAT DOES THE BILL NOT DO?
Expands insurance choices Create a mandate
Gives patients insurance options without high Require insurers to raise premiums
up-front Rx costs Prevent insurers from using deductible or co-insurance
Gives patients insurance options with predictable Require caps or limits
co-pays
Prevent insurers from offering HDHPs
Mirrors successful policies from other states
(CO, MT)
1
Colorado Division of Insurance, Bulletin NO. B-4.82, Available at: https://www.colorado.gov/pacific/dora/colorado-insurance-bulletins; Advisory Memorandum. Commissioner of Securities & Insurance. Released by the Office of the Montana State Auditor, March
2016. Available at: http://csimt.gov/wp-content/uploads/2016formfilinginstructionsfinal.pdf 2 The Moran Group. Initial Findings from the Colorado Insurance Landscape Analysis 2016. Available http://phrma-docs.phrma.org/sites/default/files/pdf/colorado-exchange-
deliverable.pdf . Accessed on August 28, 2017.