This bill addresses regulations concerning pharmacy benefits managers (PBMs), pharmacies, and prescription drugs in Iowa. It introduces several new definitions, including "pass-through pricing," which ensures that payments made by third-party payors to PBMs match what PBMs pay to pharmacies. The bill also defines "pharmacy desert" as areas with limited pharmacy access and "specialty drug" as medications requiring special handling or administration. Additionally, it mandates that 100% of rebates received by PBMs be passed on to health carriers or employer plan sponsors to help reduce premiums.

Furthermore, the bill prohibits PBMs from requiring covered individuals to exclusively use mail order pharmacies for prescription services, except for specialty drugs. It establishes reimbursement guidelines, ensuring that pharmacies with five or fewer locations receive a professional dispensing fee of $3, and those in pharmacy deserts receive the same fee regardless of their number of locations. Lastly, it prohibits the practice of spread pricing in contracts related to prescription drug benefits, effective for contracts executed or renewed after July 1, 2025.

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