Senate File 383 S-3139 Amend the amendment, S-3138, to Senate File 383, as follows: 1 1. By striking page 1, line 2, through page 10, line 10, and 2 inserting: 3 < 1. By striking everything after the enacting clause and 4 inserting: 5 < Section 1. Section 510B.1, Code 2025, is amended by adding 6 the following new subsections: 7 NEW SUBSECTION . 16A. “Pharmacy desert” means a geographic 8 area with a single pharmacy located at least thirty miles from 9 the nearest pharmacy. 10 NEW SUBSECTION . 21A. “Specialty drug” means a drug used 11 to treat chronic and complex or rare medical conditions and 12 that requires special handling or administration, provider care 13 coordination, or patient education that cannot be provided by a 14 nonspecialty pharmacy or pharmacist. 15 NEW SUBSECTION . 21B. “Spread pricing” means a pharmacy 16 benefits manager charges a third-party payor more for 17 prescription drugs dispensed to a covered person than the 18 amount the pharmacy benefits manager reimburses the pharmacy 19 for dispensing the prescription drugs to a covered person. 20 Sec. 2. NEW SECTION . 510B.4B Prohibited conduct. 21 1. a. A pharmacy benefits manager shall not do any of the 22 following: 23 (1) Where a pharmacy or pharmacist has agreed to participate 24 in a covered person’s health benefit plan, prohibit or limit 25 the covered person from selecting a pharmacy or pharmacist of 26 the covered person’s choice. 27 (2) Deny a pharmacy or pharmacist the right to participate 28 as a contract provider under a health benefit plan if the 29 pharmacy or pharmacist agrees to provide pharmacy services that 30 meet the terms and requirements of the health benefit plan and 31 the pharmacy or pharmacist agrees to the terms of reimbursement 32 set forth by the third-party payor. 33 (3) Impose upon a pharmacy or pharmacist, as a condition 34 of participation in a third-party payor network, any course 35 -1- S 3138.1787 (3) 91 nls/ko 1/ 5 #1.

of study, accreditation, certification, or credentialing that 1 is inconsistent with, more stringent than, or in addition to 2 state requirements for licensure or certification, and the 3 administrative rules adopted by the board of pharmacy. 4 (4) Require a covered person, as a condition of payment 5 or reimbursement, to purchase pharmacy services, including 6 prescription drugs, exclusively through a mail order pharmacy. 7 b. This subsection shall not apply to a specialty drug. 8 2. a. If a third-party payor providing reimbursement to 9 covered persons for prescription drugs restricts pharmacy 10 participation, the third-party payor shall notify, in writing, 11 all pharmacies within the geographical coverage area of the 12 health benefit plan restriction, and offer the pharmacies 13 the opportunity to participate in the health benefit plan at 14 least sixty days prior to the effective date of the health 15 benefit plan restriction. All pharmacies in the geographical 16 coverage area of the health benefit plan shall be eligible to 17 participate under identical reimbursement terms for providing 18 pharmacy services and prescription drugs. This paragraph shall 19 not apply to a specialty drug. 20 b. The third-party payor shall inform covered persons of 21 the names and locations of all pharmacies participating in 22 the health benefit plan as providers of pharmacy services and 23 prescription drugs. 24 c. A participating pharmacy shall be entitled to announce 25 the pharmacy’s participation in the health benefit plan to the 26 pharmacy’s customers. 27 3. The commissioner shall not certify a pharmacy benefits 28 manager or license an insurance producer that is not in 29 compliance with this section. 30 4. A covered person or pharmacy injured by a violation 31 of this section may maintain a cause of action to enjoin the 32 continuation of the violation. 33 5. This section shall not apply to an entity that owns 34 and operates the entity’s own facility, employs or contracts 35 -2- S 3138.1787 (3) 91 nls/ko 2/ 5

with physicians, pharmacists, nurses, or other health care 1 personnel, and that dispenses prescription drugs from the 2 entity’s pharmacy to the entity’s employees and dependents 3 enrolled in the entity’s health benefit plan, except that 4 this section shall apply to an entity otherwise excluded that 5 contracts with an outside pharmacy or group of pharmacies 6 to provide prescription drugs and services to the entity’s 7 employees and dependents enrolled in the entity’s health 8 benefit plan. 9 Sec. 3. Section 510B.8, Code 2025, is amended by adding the 10 following new subsection: 11 NEW SUBSECTION . 3. One hundred percent of all rebates 12 received by a pharmacy benefits manager shall be passed through 13 to the health carrier or employer plan sponsor for the purpose 14 of reducing premiums. 15 Sec. 4. Section 510B.8B, Code 2025, is amended to read as 16 follows: 17 510B.8B Pharmacy benefits manager affiliates managers —— 18 reimbursement. 19 1. A pharmacy benefits manager shall not reimburse any 20 pharmacy located in the state in an amount less than the amount 21 that the pharmacy benefits manager reimburses a pharmacy 22 benefits manager affiliate for dispensing the same prescription 23 drug as dispensed by the pharmacy. The reimbursement amount 24 shall be calculated on a per unit basis based on the same 25 generic product identifier or generic code number. 26 2. For a prescription filled at a pharmacy with five or 27 less locations, a pharmacy benefits manager shall reimburse the 28 pharmacy or pharmacist a professional dispensing fee in the 29 amount of ten dollars and sixty-eight cents. 30 3. For a prescription filled at a pharmacy with six or more 31 locations, and that has any location located in a pharmacy 32 desert, a pharmacy benefits manager shall reimburse the 33 pharmacy located in a pharmacy desert a professional dispensing 34 fee in the amount of ten dollars and sixty-eight cents. 35 -3- S 3138.1787 (3) 91 nls/ko 3/ 5

Sec. 5. NEW SECTION . 510B.8D Pharmacy benefits manager 1 contracts —— spread pricing. 2 All contracts executed, amended, adjusted, or renewed on or 3 after July 1, 2025, that apply to prescription drug benefits on 4 or after January 1, 2026, between a pharmacy benefits manager 5 and a third-party payor, or between a person and a third-party 6 payor, shall prohibit the practice of spread pricing. 7 Sec. 6. PHARMACY SERVICES ADMINISTRATIVE ORGANIZATIONS AND 8 WHOLESALE DISTRIBUTION OF PRESCRIPTION DRUGS —— REPORT. 9 1. Before January 1, 2026, the commissioner of insurance, or 10 the commissioner of insurance’s designee, shall review pharmacy 11 services administrative organizations and the wholesale 12 distribution of prescription drugs, and submit a report to the 13 general assembly containing the commissioner’s findings and 14 recommendations. The report shall include, at a minimum, all 15 of the following: 16 a. A description and analysis of the prescription drug 17 wholesale distribution supply chain, including the market 18 concentration for the wholesale distribution of prescription 19 drugs, margins in the wholesale distribution of prescription 20 drugs, and the competition in the wholesale distribution of 21 prescription drugs. 22 b. A description of the role that pharmacy services 23 administrative organizations serve in the prescription drug 24 supply chain. 25 c. A description and analysis of the relationships between 26 pharmacy services administrative organizations, prescription 27 drug wholesalers, and retail pharmacies, including but 28 not limited to standard contracting terms, fees charged to 29 pharmacies, and contractual restrictions and limitations 30 applicable to retail pharmacies. 31 2. a. The commissioner of insurance shall provide the 32 information pursuant to subsection 1 to the general assembly in 33 a format that does not publicly disclose any of the following: 34 (1) The identity of a specific pharmacy services 35 -4- S 3138.1787 (3) 91 nls/ko 4/ 5

administrative organization or prescription drug wholesaler. 1 (2) The price charged to a specific pharmacy for a specific 2 prescription drug. 3 b. Information provided under this section by the 4 commissioner to the general assembly that may reveal the 5 identity of a specific pharmacy services administrative 6 organization or prescription drug wholesaler, or the price 7 charged to a specific pharmacy for a specific prescription 8 drug, shall be considered a confidential record. > 9 2. Title page, by striking lines 1 and 2 and inserting 10 < An Act relating to pharmacy benefits managers, pharmacies, 11 prescription drugs, and pharmacy services administrative 12 organizations. >> 13 ______________________________ SARAH TRONE GARRIOTT -5- S 3138.1787 (3) 91 nls/ko 5/ 5 #2.