Bill
Bill > HSB640
IA HSB640
IA HSB640A bill for an act relating to pharmacy benefits managers, pharmacies, and prescription drug pricing, and providing applicability provisions.(See HF 2401.)
summary
Introduced
01/30/2024
01/30/2024
In Committee
01/30/2024
01/30/2024
Crossed Over
Passed
Dead
04/16/2024
04/16/2024
Introduced Session
90th General Assembly
Bill Summary
This bill relates to pharmacy benefits managers (PBMs), pharmacies, and prescription drug pricing. The bill prohibits a PBM from discriminating against a pharmacy or a pharmacist with regards to participation, referral, reimbursement of a covered service, or indemnification if a pharmacist acts within the scope of the pharmacist’s license and the pharmacy is operating in accordance with all applicable laws and rules. The bill requires all contracts executed, amended, adjusted, or renewed on or after July 1, 2024, which are applicable to prescription drug benefits on or after January 1, 2025, between a PBM and a third-party payor, or between a person and a third-party payor, to use a pass-through pricing model; to exclude terms that allow for spread pricing unless the entire amount of the difference caused by spread pricing is passed through by the pharmacy benefits manager; and to ensure that payments received in relation to providing services to a third-party payor or a pharmacy are used or distributed H.F. _____ pursuant to the PBM’s contract with the third-party payor or with the pharmacy, or as otherwise required. “Pass-through pricing” and “spread pricing” are defined in the bill. The bill requires a PBM to provide a process for pharmacies to appeal a maximum allowable cost, or a reimbursement made under a maximum allowable cost list. The requirements for the appeal process are detailed in the bill. The bill applies to pharmacy benefits managers that manage a prescription drug benefit in the state on or after July 1, 2024.
AI Summary
This Study Bill aims to regulate pharmacy benefits managers (PBMs), which are companies that manage prescription drug benefits for health plans, to promote fairer prescription drug pricing and protect pharmacies. Key provisions include prohibiting PBMs from unfairly treating pharmacies or pharmacists, requiring PBMs to use a "pass-through pricing" model where the price paid by the PBM to the pharmacy is the same as or very close to what the PBM charges the health plan, unless any difference (known as "spread pricing") is fully passed on to the patient or plan. The bill also mandates that PBM contracts must clearly state how payments are distributed and requires PBMs to establish a clear process for pharmacies to appeal reimbursement rates for drugs, ensuring that these rates are not set below the pharmacy's actual cost to acquire the drug. These regulations will apply to PBMs managing prescription drug benefits in the state starting July 1, 2024.
Committee Categories
Business and Industry
Sponsors (0)
No sponsors listed
Other Sponsors (1)
Commerce (House)
Last Action
Committee report approving bill, renumbered as HF 2401. (on 02/08/2024)
Official Document
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location | Created |
|---|---|---|
| State Bill Page | https://www.legis.iowa.gov/legislation/BillBook?ga=90&ba=HSB640 | 01/30/2024 |
| BillText | https://www.legis.iowa.gov/docs/publications/LGI/90/attachments/HSB640.html | 01/30/2024 |
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