Bill > SF383

This bill aims to regulate pharmacy benefits managers (PBMs) by introducing several key provisions to protect pharmacies and consumers in the prescription drug market. The bill defines new terms such as "national average drug acquisition cost," "pass-through pricing," and "specialty drug," and establishes rules preventing PBMs from discriminating against pharmacies or limiting patient choice. Specifically, PBMs are prohibited from imposing unfair restrictions on pharmacy participation, requiring exclusive mail-order pharmacy use, or implementing different cost-sharing based on the pharmacy a patient chooses. The bill mandates that PBMs pass 100% of drug rebates to health carriers, include all patient payments in cost-sharing calculations, and reimburse retail pharmacies based on the national average drug acquisition cost or wholesale acquisition cost. Additionally, the bill requires PBMs to provide a transparent appeals process for pharmacies to challenge reimbursement rates, submit quarterly reports on drug reimbursements, and use pass-through pricing models in their contracts with third-party payors. The legislation is set to take effect on July 1, 2025, and aims to increase transparency, fairness, and competition in the prescription drug market by placing new requirements on how pharmacy benefits managers operate.

Health And Human Services (Senate)

https://www.legis.iowa.gov/legislation/BillBook?ga=91&ba=SF383