Meeting Public Comments

Sam Miller [Infusion Access Foundation]

Dear Commmittee Members,On behalf of the Infusion Access Foundation, I am writing to urge you to support HSB 99. This crucial legislation will provide muchneeded relief to patients and families across Iowa who are struggling with high outofpocket prescription drug costs. Now is the time to take action to protect patients from harmful insurer and PBM practices.The Infusion Access Foundation is a nonprofit advocacy organization dedicated to protecting access to infusions and injections. We support patients across all disease states and advocate for expanding access to the therapies that help patients live their best, healthiest lives. In conjunction with our grassroots advocacy work, we advocate for individual patients who face significant barriers to care.HSB 99 contains two essential provisions that prioritize patients: Closing the CostSharing Loophole: Many Iowans rely on copay assistance programs to afford their lifesaving medications. However, insurers and Pharmacy Benefit Managers (PBMs) often do not count these payments toward patients' outofpocket costs, leaving them with unexpected financial burdens. This bill ensures that all payments made on behalf of an enrolleewhether from financial assistance programs or third partiescount toward their costsharing requirements. Similar "All Copays Count" legislation has already been enacted in 21 states and the District of Columbia. Ensuring 100% of Manufacturer Rebates Benefit Patients: PBMs currently retain a significant portion of manufacturer rebates rather than passing these savings on to patients. By requiring that these rebates be applied at the point of sale, HSB 99 will directly reduce outofpocket costs for those who need their medications the most.For too long, patients have been caught in a system that prioritizes middlemen over their health and wellbeing. HSB 99 is a meaningful step toward making prescription medications more affordable and ensuring that financial assistance programs truly serve their intended purposehelping patients access the care they need.We urge you to stand with Iowa patients by supporting this bill in the upcoming Health and Human Services Committee hearing. Your leadership can help bring real, positive change to individuals and families across the state.Thank you for your time and commitment to improving healthcare access and affordability in Iowa. We appreciate your support.Sincerely,Alicia Barron, LGSWExecutive DirectorInfusion Access Foundation

Sam Miller [National Infusion Center Association]

Dear Commerce Committee members, On behalf of the National Infusion Center Association, representing ambulatory infusion centers across Iowa, I urge your support for HSB 99, a critical bill that will help patients afford their prescription medications by addressing unfair costsharing practices and ensuring that manufacturer rebates benefit patients directly. The National Infusion Center Association (NICA) is a nonprofit organization formed to support nonhospital, communitybased infusion centers caring for patients in need of infused and injectable medications. To improve access to medical benefit drugs that treat complex, rare, and chronic diseases, we work to ensure that patients can access these drugs in highquality, nonhospital care settings. NICA supports policies that improve drug affordability for beneficiaries, increase price transparency, reduce disparities in quality of care and safety across care settings, and enable care delivery in the highestquality, lowestcost setting. Ambulatory infusion centers provide lifesaving therapies to patients with chronic and complex conditions. However, many of these patients struggle with excessive outofpocket drug costs due to practices that limit the impact of copay assistance programs and prevent rebates from reaching those who need them. HSB 99 tackles these issues headon in two main ways. The first is by closing the costsharing loophole used by many insurers and PBMs, ensuring that all payments made on behalf of an enrollee (including financial assistance from copay programs or third parties) count toward their deductible and outofpocket maximums. Without this fix, insurers and Pharmacy Benefit Managers (PBMs) continue to shift costs onto patients, making medications unaffordable for many who rely on them. The second is by requiring PBMs to pass 100% of manufacturer rebates to patients. PBMs currently retain a significant share of manufacturer rebates, rather than applying these savings to patients' medication costs. HSB 99 ensures rebates are applied at the point of sale, lowering outofpocket costs for patients who depend on these medications. Without this legislation, infusion centers will continue to see patients struggle to afford their treatmentsleading to delayed care, poor health outcomes, and increased financial distress. By supporting HSB 99, you will help ensure that patients can access the care they need without facing unnecessary financial barriers. As this bill moves through the Commerce Committee , we ask you to stand with Iowa patients and healthcare providers by voting YES on HSB 99. Affordable prescription medications should not be out of reach for those in need. We appreciate your leadership on this issue and look forward to your support in ensuring Iowa patients have fair access to lifesaving treatments. Please feel free to reach out if you have any questions or need further information. Sincerely, Brian Nyquist President and CEO National Infusion Center Association

Kayla Roddey [Alliance for Gout Awareness]

Please see attached letter