House
File
729
H-1221
Amend
House
File
729
as
follows:
1
1.
Page
1,
line
5,
by
striking
<
subsection
2
>
and
inserting
2
<
subsection
3
>
3
2.
Page
1,
line
33,
after
<
514J.102.
>
by
inserting
<
“Health
4
carrier”
does
not
include
the
department
of
human
services,
5
or
a
managed
care
organization
acting
pursuant
to
a
contract
6
with
the
department
of
human
services
to
administer
the
medical
7
assistance
program
under
chapter
249A
or
the
healthy
and
well
8
kids
in
Iowa
(hawk-i)
program
under
chapter
514I.
>
9
3.
Page
1,
after
line
33
by
inserting:
10
<
___.
“Incentive-based
program”
means
a
program
by
which
a
11
pharmacy
benefits
manager
or
a
health
carrier
pays
a
pharmacy
12
based
on
the
pharmacy’s
performance
in
relation
to
objective,
13
patient-focused
criteria.
>
14
4.
Page
3,
after
line
4
by
inserting:
15
<
___.
“Specialty
drug”
means
a
prescription
drug
that
a
16
health
carrier
has
designated
as
a
specialty
drug
and
that
has
17
either
of
the
following
characteristics:
18
a.
The
United
States
food
and
drug
administration
has
19
designated
the
prescription
drug
an
orphan
drug.
20
b.
The
manufacturer
of
the
prescription
drug,
or
the
United
21
States
food
and
drug
administration,
restricts
distribution
of
22
the
prescription
drug
to
a
limited
number
of
distributors.
>
23
5.
Page
3,
after
line
14
by
inserting:
24
<
Sec.
___.
Section
510B.3,
subsection
2,
Code
2021,
is
25
amended
to
read
as
follows:
26
2.
A
pharmacy
benefits
manager,
as
an
agent
or
vendor
27
of
an
insurance
company,
is
subject
to
the
commissioner’s
28
authority
to
conduct
an
examination
pursuant
to
chapter
507
.
29
The
procedures
set
forth
in
chapter
507
regarding
examination
30
reports
examinations
shall
apply
to
an
examination
of
a
31
pharmacy
benefits
manager
under
this
chapter
.
>
32
6.
Page
4,
line
30,
after
<
1.
>
by
inserting
<
a.
>
33
7.
Page
4,
after
line
33
by
inserting:
34
<
b.
Notwithstanding
paragraph
“a”
,
a
pharmacy
located
in
the
35
-1-
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(3)
89
ko/rn
1/
3
#1.
#2.
#3.
#4.
#5.
#6.
#7.
state
may
be
prohibited
from
participating
in
a
specialty
drug
1
pharmacy
network
even
if
the
pharmacy
accepts
the
same
terms
2
and
conditions
as
the
pharmacy
benefits
manager
imposes
on
the
3
pharmacies
in
the
specialty
drug
pharmacy
network.
>
4
8.
Page
5,
line
21,
after
<
4.
>
by
inserting
<
a.
>
5
9.
Page
5,
line
24,
by
striking
<
at
least
>
and
inserting
6
<
other
pharmacies
in
the
same
network.
>
7
10.
Page
5,
by
striking
lines
25
and
26.
8
11.
Page
5,
before
line
27
by
inserting:
9
<
b.
Notwithstanding
paragraph
“a”
,
a
covered
person
may
10
be
prohibited
from
filling
a
prescription
drug
order
for
a
11
specialty
drug
at
certain
pharmacies
located
in
the
state
12
even
if
the
pharmacy
accepts
the
same
terms
and
conditions
13
as
the
pharmacy
benefits
manager
imposes
on
at
least
one
of
14
the
pharmacy
networks
that
the
pharmacy
benefits
manager
has
15
established
in
the
state
for
filling
the
same
type
of
specialty
16
drug
prescription
drug
orders.
>
17
12.
Page
5,
line
27,
after
<
5.
>
by
inserting
<
a.
>
18
13.
Page
5,
after
line
30
by
inserting:
19
<
b.
Notwithstanding
paragraph
“a”
,
a
pharmacy
benefits
20
manager
may
impose
different
cost-sharing
or
additional
21
fees
on
a
covered
person
based
on
the
pharmacy
at
which
the
22
covered
person
fills
the
covered
person’s
prescription
drug
23
order
if
the
cost-sharing
or
additional
fees
are
related
to
24
a
prescription
drug
order
for
a
specialty
drug,
or
to
an
25
incentive-based
program.
>
26
14.
Page
5,
line
31,
after
<
6.
>
by
inserting
<
a.
>
27
15.
Page
5,
after
line
35
by
inserting:
28
<
b.
If
a
pharmacy
declines
to
dispense
a
prescription
drug
29
to
a
covered
person
under
paragraph
“a”
,
the
pharmacy
shall
30
dispense
a
substitute
prescription
drug
if
permitted
pursuant
31
to
section
510B.6.
>
32
16.
Page
6,
line
2,
by
striking
<
drug
>
and
inserting
<
drug,
33
other
than
a
specialty
drug,
>
34
17.
Page
7,
line
2,
before
<
A
>
by
inserting
<
1.
>
35
-2-
HF729.1406
(3)
89
ko/rn
2/
3
#8.
#9.
#10.
#11.
#12.
#13.
#14.
#15.
#16.
18.
Page
7,
line
6,
after
<
pharmacy
>
by
inserting
<
,
1
unless
the
difference
in
the
reimbursement
amount
is
due
to
an
2
incentive-based
program
in
which
the
pharmacy
is
participating
>
3
19.
Page
7,
after
line
8
by
inserting:
4
<
2.
Notwithstanding
subsection
1,
a
pharmacy
benefits
5
manager
may
reimburse
any
pharmacy
located
in
the
state
in
an
6
amount
less
than
the
amount
that
the
pharmacy
benefits
manager
7
reimburses
a
pharmacy
benefits
manager
affiliate
for
dispensing
8
the
same
specialty
drug
as
dispensed
by
the
pharmacy.
>
9
20.
Page
7,
line
14,
by
striking
<
audit
>
and
inserting
10
<
audit,
the
claim
has
been
fraudulently
submitted,
or
the
claim
11
is
duplicative
of
a
claim
that
has
already
been
paid
>
12
21.
Page
8,
by
striking
lines
11
through
13.
13
22.
Page
8,
by
striking
lines
15
through
31
and
inserting
14
<
appeal,
the
pharmacy
benefits
manager
shall
provide
the
15
appealing
pharmacy
the
national
drug
code
number
and
the
name
16
of
a
wholesale
distributor
licensed
pursuant
to
section
155A.17
17
from
which
the
pharmacy
can
obtain
the
prescription
drug
at
or
18
below
the
maximum
allowable
cost.
>
19
23.
By
striking
page
9,
line
7,
through
page
10,
line
15.
20
24.
Page
10,
after
line
25
by
inserting:
21
<
Sec.
___.
NEW
SECTION
.
510B.13
Applicability.
22
This
chapter
shall
not
apply
to
a
health
benefit
plan
that
23
provides
a
prescription
drug
benefit
for
Medicare
beneficiaries
24
under
Medicare
part
D,
42
U.S.C.
§1395w-101
et
seq.,
and
that
25
is
administered
by
a
pharmacy
benefits
manager.
>
26
25.
Page
10,
line
26,
by
striking
<
510B.3
>
and
inserting
27
<
510B.10
>
28
26.
By
renumbering,
redesignating,
and
correcting
internal
29
references
as
necessary.
30
______________________________
BEST
of
Carroll
-3-
HF729.1406
(3)
89
ko/rn
3/
3
#18.
#19.
#20.
#21.
#22.
#23.
#24.
#25.
#26.