HF 213 (LSB 1831YH (2) 91)

HOUSE FILE 213

BY  EHLERT, BAGNIEWSKI, SRINIVAS, WILSON, KRESSIG, BROWN-POWERS, and B. MEYER

A BILL FOR

An Act relating to pharmacy benefits managers, pharmacies, and prescription drug benefits, and including applicability provisions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  Section 510B.1, Code 2025, is amended by adding the following new subsection:
   NEW SUBSECTION.  9A.  “Mail order pharmacy provider” means a pharmacy whose primary business is to dispense a prescription drug or device under a prescription drug order and to deliver the prescription drug or device to a covered person by mail, common carrier, or delivery service.
    Sec. 2.  Section 510B.8, Code 2025, is amended by adding the following new subsections:
   NEW SUBSECTION.  3.  Any amount paid by a covered person for a prescription drug purchased pursuant to this section shall be applied to any deductible imposed by the covered person’s health benefit plan in accordance with the health benefit plan coverage documents.
   NEW SUBSECTION.  4.  A covered person shall not be prohibited from filling a prescription drug order at any pharmacy located in the state provided that the pharmacy accepts the same terms and conditions as the pharmacies participating in the covered person’s health benefit plan’s network.
   NEW SUBSECTION.  5.  Excluding incentives in value-based programs established by a health carrier or a pharmacy benefits manager to promote the use of higher quality pharmacies, a pharmacy benefits manager shall not impose different cost-sharing or additional fees on a covered person based on the pharmacy at which the covered person fills the covered person’s prescription drug order.
   NEW SUBSECTION.  6.  A pharmacy benefits manager shall not require a covered person, as a condition of payment or reimbursement, to purchase pharmacy services, including prescription drugs, exclusively through a mail order pharmacy provider.
    Sec. 3.  APPLICABILITY.  This Act applies to pharmacy benefits managers that manage a health carrier’s prescription drug benefit in the state on or after the effective date of this Act.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill relates to pharmacy benefits managers (PBM), pharmacies, and prescription drug benefits.
   The bill requires that any amount paid by a covered person for a drug in the circumstances detailed in the bill must be applied to any deductible imposed by the covered person’s health benefit plan in accordance with the plan’s coverage documents. Under the bill, a covered person cannot be prohibited from filling a drug order at any pharmacy located in the state if the pharmacy accepts the same terms and conditions as the covered person’s benefit plan. A PBM cannot impose different cost-sharing or additional fees on a covered person based on the pharmacy at which a covered person fills their prescription. A PBM cannot require a covered person, as a condition of payment or reimbursement, to purchase pharmacy services, including drugs, exclusively through a mail order pharmacy provider. “Mail order pharmacy provider” is defined in the bill.
   The bill applies to PBMs that manage a health carrier’s prescription drug benefit in the state on or after the effective date of the bill.