Senate File 383 S-3104 Amend Senate File 383 as follows: 1 1. Page 2, by striking lines 12 and 13 and inserting 2 < reduction in reimbursement for services, a promotion of 3 one participating pharmacy over another, or comparing the 4 reimbursement rates of a pharmacy against mail order pharmacy 5 reimbursement rates. > 6 2. Page 2, line 19, after < payor > by inserting < for 7 similarly classified pharmacies > 8 3. Page 4, by striking lines 19 through 31 and inserting: 9 < NEW SUBSECTION . 4. For the purpose of reducing premiums, 10 one hundred percent of all rebates received by a pharmacy 11 benefits manager shall be passed through to the health carrier, 12 or to the employee plan sponsor as permitted by the federal 13 Employee Retirement Income Security Act of 1974, 29 U.S.C. 14 §1001, et seq. > 15 4. Page 5, after line 5 by inserting: 16 < NEW SUBSECTION . 7. If a covered person’s policy, contract, 17 or plan providing for third-party payment or prepayment of 18 health or medical expenses qualifies as a high-deductible 19 health plan under section 223 of the Internal Revenue Code, 20 and a copayment, coinsurance, or deductible paid by the 21 covered person as a cost-sharing requirement under this chapter 22 would result in the covered person becoming ineligible for a 23 health savings account associated with the covered person’s 24 high-deductible health plan, subsection 5 shall apply only 25 after the covered person satisfies the covered person’s minimum 26 deductible, except for items or services determined to be 27 preventive care under section 223(c)(2)(C) of the Internal 28 Revenue Code. > 29 5. By striking page 5, line 34, through page 6, line 1, and 30 inserting < report to the commissioner, in a form approved by 31 the commissioner, of all drugs reimbursed below the national 32 average drug acquisition cost, and all drugs reimbursed ten 33 percent or more above the national > 34 6. Page 6, after line 21 by inserting: 35 -1- SF 383.1489 (1) 91 nls/ko 1/ 4 #1. #2. #3. #4. #5. #6.

< e. Upon the request of the commissioner, a pharmacy 1 benefits manager shall provide the commissioner with any 2 additional information pursuant to paragraph “b” in a form and 3 manner prescribed by the commissioner in a manner that does not 4 publicly disclose the information, and that complies with the 5 federal Health Insurance Portability and Accountability Act of 6 1996, Pub. L. No. 104-191. Requested information may include 7 but is not limited to health benefit plan, manufacturer, or 8 market specific information. > 9 7. By striking page 6, line 31, through page 7, line 4, and 10 inserting < pricing. > 11 8. Page 7, line 5, by striking < c. > and inserting < b. > 12 9. Page 7, by striking lines 19 through 21 and inserting 13 < process to allow a pharmacy to appeal any matter. > 14 10. Page 8, line 1, after < appeal > by inserting < related to 15 a reimbursement rate > 16 11. Page 8, by striking lines 16 through 18 and inserting: 17 < b. If the pharmacy benefits manager denies a pharmacy’s 18 appeal, the pharmacy benefits manager shall do all of the 19 following: 20 (1) Provide the appealing pharmacy the national drug 21 code number and the name of a wholesale distributor licensed 22 pursuant to section 155A.17 from which the pharmacy can obtain 23 the prescription drug at or below the reimbursement rate. 24 (2) If the prescription drug identified by the national 25 drug code number provided by the pharmacy benefits manager 26 pursuant to subparagraph (1) is not available below the 27 pharmacy acquisition cost from the wholesale distributor from 28 whom the pharmacy purchases the majority of its prescription 29 drugs for resale, the pharmacy benefits manager shall adjust 30 the reimbursement rate above the appealing pharmacy’s pharmacy 31 acquisition cost, and reverse and resubmit each claim affected 32 by the pharmacy’s inability to procure the prescription drug 33 at a cost that is equal to or less than the previously appealed 34 reimbursement rate. 35 -2- SF 383.1489 (1) 91 nls/ko 2/ 4 #7. #8. #9. #10. #11.

Sec. ___. PHARMACY SERVICES ADMINISTRATIVE ORGANIZATIONS 1 AND WHOLESALE DISTRIBUTION OF PRESCRIPTION DRUGS —— REPORT. 2 1. Before January 1, 2026, the commissioner of insurance, or 3 the commissioner of insurance’s designee, shall review pharmacy 4 services administrative organizations and the wholesale 5 distribution of prescription drugs, and submit a report to the 6 general assembly containing the commissioner’s findings and 7 recommendations. The report shall include, at a minimum, all 8 of the following: 9 a. A description and analysis of the prescription drug 10 wholesale distribution supply chain, including the market 11 concentration for the wholesale distribution of prescription 12 drugs, margins in the wholesale distribution of prescription 13 drugs, and the competition in the wholesale distribution of 14 prescription drugs. 15 b. A description of the role that pharmacy services 16 administrative organizations serve in the prescription drug 17 supply chain. 18 c. A description and analysis of the relationships between 19 pharmacy services administrative organizations, prescription 20 drug wholesalers, and retail pharmacies, including but 21 not limited to standard contracting terms, fees charged to 22 pharmacies, and contractual restrictions and limitations 23 applicable to retail pharmacies. 24 2. a. The commissioner of insurance shall provide the 25 information pursuant to subsection 1 to the general assembly in 26 a format that does not publicly disclose any of the following: 27 (1) The identity of a specific pharmacy services 28 administrative organization or prescription drug wholesaler. 29 (2) The price charged to a specific pharmacy for a specific 30 prescription drug. 31 b. Information provided under this section by the 32 commissioner to the general assembly that may reveal the 33 identity of a specific pharmacy services administrative 34 organization or prescription drug wholesaler, or the price 35 -3- SF 383.1489 (1) 91 nls/ko 3/ 4

charged to a specific pharmacy for a specific prescription 1 drug, shall be considered a confidential record. > 2 12. Page 8, line 20, by striking < managers > and inserting 3 < managers, health carriers, third-party payors, and health 4 benefit plans > 5 13. Title page, by striking lines 1 and 2 and inserting 6 < An Act relating to pharmacy benefits managers, pharmacies, 7 prescription drugs, and pharmacy services administrative 8 organizations, and including applicability provisions. > 9 14. By renumbering as necessary. 10 ______________________________ MIKE KLIMESH -4- SF 383.1489 (1) 91 nls/ko 4/ 4 #12. #13. #14.