S-5182

   Amend House File 2384, as amended, passed, and reprinted by the House, as follows:
   1.  Page 1, by striking lines 1 through 4 and inserting: 
<DIVISION I
PHARMACY BENEFITS MANAGERS, PHARMACIES, AND PRESCRIPTION DRUG BENEFITS>
   2.  Page 1, after line 26 by inserting: 
   <___.  “Facility” means an institution providing health care services or a health care setting, including but not limited to hospitals and other licensed inpatient centers, ambulatory surgical or treatment centers, skilled nursing centers, residential treatment centers, diagnostic, laboratory and imaging centers, and rehabilitation and other therapeutic health settings.>
   3.  Page 1, by striking lines 27 through 30 and inserting: 
   <___.  “Health benefit plan” means a policy, contract, certificate, or agreement offered or issued by a third-party payor to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services.
   ___.  “Health care professional” means a physician or other health care practitioner licensed, accredited, registered, or certified to perform specified health care services consistent with state law.
   ___.  “Health care provider” means a health care professional or a facility.>
   4.  Page 2, by striking lines 1 through 9 and inserting <corporation, or a plan established pursuant to chapter 509A for public employees. “Health carrier” does not include any of the following:>
   5.  Page 2, before line 10 by inserting: 
   <a.  The department of human services.
   b.  A managed care organization acting pursuant to a contract with the department of human services to administer the medical assistance program under chapter 249A or the healthy and well kids in Iowa (hawk-i) program under chapter 514I.
   c.  A policy or contract providing a prescription drug benefit pursuant to 42 U.S.C. ch. 7, subch. XVIII, part D.
   d.  A plan offered or maintained by a multiple employer welfare arrangement established under chapter 513D before January 1, 2022.>
   6.  Page 3, by striking lines 4 and 5 and inserting: 
   <___.  “Pharmacy benefits manager” means a person who, pursuant to a contract or other relationship with a third-party payor, either directly or through an intermediary, manages a prescription drug benefit provided by the third-party payor.>
   7.  Page 3, by striking lines 18 and 19 and inserting: 
   <___.  “Prescription drug benefit” means a health benefit plan providing for third-party payment or prepayment for prescription drugs.>
   8.  Page 3, by striking line 22 and inserting: 
   <___.  “Rebate” means all discounts and other negotiated price concessions paid directly or indirectly by a pharmaceutical manufacturer or other entity, other than a covered person, in the prescription drug supply chain to a pharmacy benefits manager, and which may be based on any of the following:
   a.  A pharmaceutical manufacturer’s list price for a prescription drug.
   b.  Utilization.
   c.  To maintain a net price for a prescription drug for a specified period of time for the pharmacy benefits manager in the event the pharmaceutical manufacturer’s list price increases.
   d.  Reasonable estimates of the volume of a prescribed drug that will be dispensed by a pharmacy to covered persons.
   ___.  “Third-party payor” means any entity other than a covered person or a health care provider that is responsible for any amount of reimbursement for a prescription drug benefit. “Third-party payor” includes health carriers and other entities that provide a plan of health insurance or health care benefits. “Third-party payor” does not include any of the following:
   a.  The department of human services.
   b.  A managed care organization acting pursuant to a contract with the department of human services to administer the medical assistance program under chapter 249A or the healthy and well kids in Iowa (hawk-i) program under chapter 514I.
   c.  A policy or contract providing a prescription drug benefit pursuant to 42 U.S.C. ch. 7, subch. XVIII, part D.>
   9.  Page 3, line 33, by striking <health carrier> and inserting <third-party payor>
   10.  Page 4, line 4, by striking <health carrier> and inserting <third-party payor>
   11.  Page 4, line 6, by striking <health carrier> and inserting <third-party payor>
   12.  Page 4, by striking lines 8 through 13.
   13.  Page 5, by striking lines 14 through 17.
   14.  By striking page 6, line 1, through page 7, line 18.
   15.  By striking page 9, line 2, through page 10, line 23.
   16.  Page 12, line 16, before <Act> by inserting <division of this>
   17.  Page 12, line 17, by striking <health carrier’s>
   18.  Page 12, by striking lines 20 through 24 and inserting: 
<DIVISION ___
PHARMACY BENEFITS MANAGER REPORTING

   Sec. ___.  Section 510C.1, Code 2022, is amended to read as follows:
   510C.1  Definitions.
   As used in this chapter unless the context otherwise requires:
   1.  “Administrative fees” means a fee or payment, other than a rebate, under a contract between a pharmacy benefits manager and a pharmaceutical drug manufacturer in connection with the pharmacy benefits manager’s management of a health carrier’s third-party payor’s prescription drug benefit, that is paid by a pharmaceutical drug manufacturer to a pharmacy benefits manager or is retained by the pharmacy benefits manager.
   2.  “Aggregate retained rebate percentage” means the percentage of all rebates received by a pharmacy benefits manager that is not passed on to the pharmacy benefits manager’s health carrier third-party payor clients.
   3.  “Commissioner” means the commissioner of insurance.
   4.  “Covered person” means the same as defined in section 514J.102 510B.1.
   5.  “Formulary” means a complete list of prescription drugs eligible for coverage under a health benefit plan.
   6.  “Health benefit plan” means the same as defined in section 514J.102 510B.1.
   7.  “Health carrier” means the same as defined in section 514J.102 510B.1.
   8.  “Health carrier administrative service fee” means a fee or payment under a contract between a pharmacy benefits manager and a health carrier in connection with the pharmacy benefits manager’s administration of the health carrier’s prescription drug benefit that is paid by a health carrier to a pharmacy benefits manager or is otherwise retained by a pharmacy benefits manager.
   9.  8.  “Pharmacy benefits manager” means a person who, pursuant to a contract or other relationship with a health carrier, either directly or through an intermediary, manages a prescription drug benefit provided by the health carrier the same as defined in section 510B.1.
   10.  9.  “Prescription drug benefit” means a health benefit plan providing for third-party payment or prepayment for prescription drugs the same as defined in section 510B.1.
   11.  10.  “Rebate” means all discounts and other negotiated price concessions paid directly or indirectly by a pharmaceutical manufacturer or other entity, other than a covered person, in the prescription drug supply chain to a pharmacy benefits manager, and which may be based on any of the following: the same as defined in section 510B.1.
   a.  A pharmaceutical manufacturer’s list price for a prescription drug.
   b.  Utilization.
   c.  To maintain a net price for a prescription drug for a specified period of time for the pharmacy benefits manager in the event the pharmaceutical manufacturer’s list price increases.
   d.  Reasonable estimates of the volume of a prescribed drug that will be dispensed by a pharmacy to covered persons.
   11.  “Third-party payor” means the same as defined in section 510B.1.
   12.  “Third-party payor administrative service fee” means a fee or payment under a contract between a pharmacy benefits manager and a third-party payor in connection with the pharmacy benefits manager’s administration of the third-party payor’s prescription drug benefit that is paid by a third-party payor to a pharmacy benefits manager or is otherwise retained by a pharmacy benefits manager.
   Sec. ___.  Section 510C.2, subsection 1, unnumbered paragraph 1, Code 2022, is amended to read as follows:
   Each pharmacy benefits manager shall provide a report annually by February 15 to the commissioner that contains all of the following information regarding prescription drug benefits provided to covered persons of each health carrier third-party payor with whom the pharmacy benefits manager has contracted during the prior calendar year:
   Sec. ___.  Section 510C.2, subsection 1, paragraphs c, d, e, and g, Code 2022, are amended to read as follows:
   c.  The aggregate dollar amount of all health carrier third-party payor administrative service fees received by the pharmacy benefits manager.
   d.  The aggregate dollar amount of all rebates received by the pharmacy benefits manager that the pharmacy benefits manager did not pass through to the health carrier third-party payor.
   e.  The aggregate amount of all administrative fees received by the pharmacy benefits manager that the pharmacy benefits manager did not pass through to the health carrier third-party payor.
   g.  Across all health carrier third-party payor clients with whom the pharmacy benefits manager was contracted, the highest and the lowest aggregate retained rebate percentages.
   Sec. ___.  Section 510C.2, subsection 2, paragraph a, subparagraph (1), Code 2022, is amended to read as follows:
   (1)  The identity of a specific health carrier third-party payor.
   Sec. ___.  Section 510C.2, subsection 2, paragraph b, Code 2022, is amended to read as follows:
   b.  Information provided under this section by a pharmacy benefits manager to the commissioner that may reveal the identity of a specific health carrier third-party payor, the price charged by a specific pharmaceutical manufacturer for a specific prescription drug or class of prescription drugs, or the amount of rebates provided for a specific prescription drug or class of prescription drugs shall be considered a confidential record and be recognized and protected as a trade secret pursuant to section 22.7, subsection 3.
DIVISION ___
EMERGENCY RULEMAKING

   Sec. ___.  EMERGENCY RULES.  The insurance division of the department of commerce may adopt emergency rules under section 17A.4, subsection 3, and section 17A.5, subsection 2, paragraph “b”, to implement the provisions of this Act and the rules shall be effective immediately upon filing unless a later date is specified in the rules. Any rules adopted in accordance with this section shall also be published as a notice of intended action as provided in section 17A.4.
DIVISION ___
EFFECTIVE DATE

   Sec. ___.  EFFECTIVE DATE.  This Act, being deemed of immediate importance, takes effect upon enactment.>
   19.  Title page, line 2, after <including> by inserting <effective date and>
   20.  By renumbering, redesignating, and correcting internal references as necessary.

______________________________
MIKE KLIMESH