The bill establishes a Prescription Drug Affordability Board in Iowa, designed to tackle the escalating costs of prescription drugs affecting patients, healthcare providers, and state governments. Comprising five members appointed by the governor, the board will operate under strict conflict-of-interest guidelines and is responsible for conducting affordability reviews of prescription drugs, particularly those with high launch prices or significant price increases. The board will recommend upper payment limits for these drugs and is required to meet publicly at least four times a year, while also forming a stakeholder council to gather input from various industry representatives.

In addition to its review responsibilities, the bill mandates the board to report annually to the General Assembly on price trends and recommendations for enhancing drug affordability. It outlines the board's powers, including access to pricing information and the ability to contract with third parties for necessary services. The bill also introduces new protocols for transparency, such as mandatory public comment opportunities and expert testimony during meetings, while requiring board members to disclose conflicts of interest and recuse themselves from decisions where they or their immediate family may have financial interests. Furthermore, the board must identify drugs posing affordability challenges and report its findings, including a specific report on the generic drug market due by July 1, 2026.