This bill introduces comprehensive regulations for pharmacy benefit managers (PBMs) in Iowa, focusing on transparency and fairness in the prescription drug market. It defines key terms such as "national average drug acquisition cost," "pass-through pricing," and "spread pricing." The legislation prohibits PBMs from discriminating against pharmacies or pharmacists in terms of participation and reimbursement, ensuring that covered individuals can choose their pharmacy without incurring penalties or higher costs. Additionally, it mandates that PBMs cannot impose unreasonable conditions for pharmacy participation and must provide a clear appeals process for reimbursement disputes.

The bill further stipulates that PBMs must reimburse pharmacies at least at the national average drug acquisition cost or the wholesale acquisition cost, along with a professional dispensing fee of $10.60. It requires that cost-sharing for prescriptions be calculated at the point of sale, incorporating a minimum percentage of all rebates received by health carriers or PBMs. All contracts related to prescription benefits executed after July 1, 2025, must utilize a pass-through pricing model to ensure transparency. The legislation also establishes an appeal process for pharmacies to contest reimbursement rates and mandates quarterly reporting by PBMs on their operations, enhancing accountability in the management of prescription drug benefits, effective from July 1, 2025.

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