Senate File 383 aims to regulate pharmacy benefits managers (PBMs) and enhance the rights of pharmacies and pharmacists in Iowa. The bill introduces several new definitions, including "national average drug acquisition cost," "pass-through pricing," and "specialty drug," among others. It prohibits PBMs from discriminating against pharmacies or pharmacists regarding participation and reimbursement, and it establishes that PBMs cannot impose different cost-sharing based on the pharmacy used by a covered person. Additionally, the bill mandates that all contracts between PBMs and third-party payors include provisions for pass-through pricing and requires PBMs to report on reimbursement practices.

The legislation also outlines specific rights for pharmacies, such as the ability to appeal reimbursement decisions and mandates that PBMs respond to these appeals within a set timeframe. Furthermore, it requires that all rebates received by PBMs be passed through to health carriers or employee plan sponsors to help reduce premiums. The bill includes provisions for a report on pharmacy services administrative organizations and the wholesale distribution of prescription drugs, which must be submitted by January 1, 2026. Overall, the bill seeks to create a more equitable environment for pharmacies and improve transparency in the prescription drug pricing system.

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