A bill for an act relating to pharmacy benefits managers, pharmacies, and prescription drug benefits, and including applicability provisions.
Summary
HF 213 would regulate how pharmacy benefits managers (PBMs) and health benefit plans treat prescription drug purchases made at different pharmacies in Iowa. The bill defines “mail order pharmacy provider” and then requires that amounts paid by a covered person for a prescription drug be credited toward the person’s deductible when the plan documents so provide. It also prohibits a covered person from being blocked from filling a prescription at any Iowa pharmacy that agrees to the same network terms and conditions as participating pharmacies.
The bill further bars PBMs from charging different cost-sharing amounts or extra fees based solely on which pharmacy a person uses, except for incentives tied to value-based programs intended to encourage higher-quality pharmacies. It also prevents PBMs from requiring, as a condition of payment or reimbursement, that a person obtain pharmacy services exclusively through a mail-order pharmacy provider. The bill applies to PBMs managing a health carrier’s prescription drug benefit in Iowa on or after the effective date.
Impact
HF 213 would amend Iowa Code chapter 510B governing pharmacy benefits managers and prescription drug benefits, adding new consumer-protection rules for deductible crediting, pharmacy choice, and limits on PBM steering toward mail-order pharmacies. It would affect PBMs, health carriers, pharmacies, and covered persons by restricting differential pricing and network practices tied to pharmacy location, while preserving value-based incentive programs. The bill’s applicability is prospective and limited to PBMs managing prescription drug benefits in the state after the effective date.
Sentiment
The available record shows the bill was introduced and referred to the House Commerce Committee, with no recorded votes or committee transcript in the provided materials. Based on the bill’s structure, the measure appears consumer- and pharmacy-friendly, aiming to expand access and limit PBM restrictions, but there is no direct evidence in the record of support or opposition from legislators, stakeholders, or the public.
Contention
The main policy tensions likely center on PBM steering practices, mail-order pharmacy requirements, and whether limiting differential cost-sharing interferes with plan design or cost-containment strategies. Supporters would likely favor the bill for protecting patient choice, preventing hidden fees, and ensuring deductible credit for out-of-pocket drug spending. Potential opponents may argue that the bill reduces PBM flexibility to negotiate lower prices, manage formularies, or encourage use of preferred pharmacies and mail-order channels, though no specific objections are documented in the provided history.
A bill for an act relating to pharmacy benefits managers, pharmacies, prescription drugs, and pharmacy services administrative organizations, and including applicability provisions. (Formerly SSB 1074.) Effective date: 07/01/2025. Applicability date: 07/01/2025.
A bill for an act relating to pharmacy benefits managers, pharmacies, prescription drugs, and pharmacy services administrative organizations, and including applicability provisions. (Formerly SSB 1074.) Effective date: 07/01/2025. Applicability date: 07/01/2025.