This bill introduces new regulations for pharmacy benefit managers (PBMs) in Iowa, focusing on enhancing transparency and fairness in prescription drug pricing. It defines "pass-through pricing" and "spread pricing," and prohibits PBMs from discriminating against pharmacies or pharmacists based on their compliance with applicable laws. The legislation ensures that PBMs cannot restrict a covered person's choice of pharmacy or impose penalties affecting their selection. Additionally, any restrictions on pharmacy participation by third-party payors must be communicated to all pharmacies at least 60 days before implementation.

The bill mandates that PBMs reimburse pharmacies at rates equal to the national average drug acquisition cost, Iowa average acquisition cost, or wholesale acquisition cost, and requires a professional dispensing fee aligned with the Iowa Medicaid enterprise provider fee schedule. It also establishes that all contracts related to prescription drug benefits executed or renewed after July 1, 2025, must adopt a pass-through pricing model and prohibit spread pricing unless the full difference is passed through to the pharmacy. An appeals process for pharmacies to contest reimbursement rates is also included, with the new regulations set to take effect for PBMs managing prescription drug benefits in Iowa starting January 1, 2026.

Statutes affected:
Introduced: 510B.1, 510B.4, 510B.8, 510B.8B