SF 333 – Iowa

Status: In Process
Year Introduced: 2024
Link: https://www.legis.iowa.gov/legislation/BillBook?ga=90&ba=SF333

This bill aims to regulate pharmacy benefits managers (PBMs), pharmacies, and prescription drug benefits. It requires that any payments a covered person makes for a prescription drug must be applicable to any deductibles in the person’s health benefit plan. It states that a covered person must be permitted to fill a prescription at any pharmacy within the state, given the terms and conditions of their health benefit plan are accepted by the selected pharmacy. It explicitly prohibits PBMs from imposing different cost-sharing or additional fees based on the selection of the pharmacy by a covered person. PBMs are also prohibited from requiring a person to purchase pharmacy services or drugs strictly from a mail-order pharmacy. The bill mandates that PBMs must provide each pharmacy in a network access to the maximum allowable cost list, available through a secure internet site, and a process for pharmacies to appeal a maximum allowable cost or a reimbursement made under the maximum allowable cost list. The bill only applies to PBMs that manage a health carrier’s prescription drug benefit in the state after the bill becomes effective.

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