SF 284 – Iowa

Status: In Process
Year Introduced: 2024
Link: https://www.legis.iowa.gov/legislation/BillBook?ga=90&ba=SF284

This bill proposes a system to ensure the provision of pharmacy benefit services through a competitive online auction process. This auction, referred to as a “Pharmacy Benefits Manager Reverse Auction”, is meant to foster competition among Pharmacy Benefit Managers (PBMs), companies that manage prescription drug benefits on behalf of health insurers. The bill lays out rules and procedures for the auction, stipulating that the lowest-cost PBM will be awarded a service contract. The bill also specifies the use of technology platforms to manage the auction and evaluate bids, and it prohibits awarding contracts to vendors that are PBMs themselves or are affiliated with a PBM. Moreover, the Department of Administration Services (DAS) is obliged to utilize this technology to perform real-time, electronic, claim-by-claim review of all invoiced PBM prescription drug claims to guarantee compliance with the service contract terms. In case of payment disputes, a dispute resolution mechanism is laid out. Effective from July 1, 2024, each PBM service contract must be awarded at least three months before the termination of the previous contract. The program, however, shall not apply to nonprofit, nongovernmental health maintenance organizations providing a majority of their services through a single contracted medical group. Lastly, both self-funded public and private sector health plans can elect to participate in the reverse auction, maintaining autonomy over their individual health plans.

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