Read the full stored bill text
House
File
213
-
Introduced
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
1
prescription
drug
benefits,
and
including
applicability
2
provisions.
3
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
4
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213
Section
1.
Section
510B.1,
Code
2025,
is
amended
by
adding
1
the
following
new
subsection:
2
NEW
SUBSECTION
.
9A.
“Mail
order
pharmacy
provider”
means
a
3
pharmacy
whose
primary
business
is
to
dispense
a
prescription
4
drug
or
device
under
a
prescription
drug
order
and
to
deliver
5
the
prescription
drug
or
device
to
a
covered
person
by
mail,
6
common
carrier,
or
delivery
service.
7
Sec.
2.
Section
510B.8,
Code
2025,
is
amended
by
adding
the
8
following
new
subsections:
9
NEW
SUBSECTION
.
3.
Any
amount
paid
by
a
covered
person
for
10
a
prescription
drug
purchased
pursuant
to
this
section
shall
11
be
applied
to
any
deductible
imposed
by
the
covered
person’s
12
health
benefit
plan
in
accordance
with
the
health
benefit
plan
13
coverage
documents.
14
NEW
SUBSECTION
.
4.
A
covered
person
shall
not
be
prohibited
15
from
filling
a
prescription
drug
order
at
any
pharmacy
located
16
in
the
state
provided
that
the
pharmacy
accepts
the
same
terms
17
and
conditions
as
the
pharmacies
participating
in
the
covered
18
person’s
health
benefit
plan’s
network.
19
NEW
SUBSECTION
.
5.
Excluding
incentives
in
value-based
20
programs
established
by
a
health
carrier
or
a
pharmacy
benefits
21
manager
to
promote
the
use
of
higher
quality
pharmacies,
22
a
pharmacy
benefits
manager
shall
not
impose
different
23
cost-sharing
or
additional
fees
on
a
covered
person
based
on
24
the
pharmacy
at
which
the
covered
person
fills
the
covered
25
person’s
prescription
drug
order.
26
NEW
SUBSECTION
.
6.
A
pharmacy
benefits
manager
shall
27
not
require
a
covered
person,
as
a
condition
of
payment
28
or
reimbursement,
to
purchase
pharmacy
services,
including
29
prescription
drugs,
exclusively
through
a
mail
order
pharmacy
30
provider.
31
Sec.
3.
APPLICABILITY.
This
Act
applies
to
pharmacy
32
benefits
managers
that
manage
a
health
carrier’s
prescription
33
drug
benefit
in
the
state
on
or
after
the
effective
date
of
34
this
Act.
35
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EXPLANATION
1
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
2
the
explanation’s
substance
by
the
members
of
the
general
assembly.
3
This
bill
relates
to
pharmacy
benefits
managers
(PBM),
4
pharmacies,
and
prescription
drug
benefits.
5
The
bill
requires
that
any
amount
paid
by
a
covered
person
6
for
a
drug
in
the
circumstances
detailed
in
the
bill
must
7
be
applied
to
any
deductible
imposed
by
the
covered
person’s
8
health
benefit
plan
in
accordance
with
the
plan’s
coverage
9
documents.
Under
the
bill,
a
covered
person
cannot
be
10
prohibited
from
filling
a
drug
order
at
any
pharmacy
located
in
11
the
state
if
the
pharmacy
accepts
the
same
terms
and
conditions
12
as
the
covered
person’s
benefit
plan.
A
PBM
cannot
impose
13
different
cost-sharing
or
additional
fees
on
a
covered
person
14
based
on
the
pharmacy
at
which
a
covered
person
fills
their
15
prescription.
A
PBM
cannot
require
a
covered
person,
as
a
16
condition
of
payment
or
reimbursement,
to
purchase
pharmacy
17
services,
including
drugs,
exclusively
through
a
mail
order
18
pharmacy
provider.
“Mail
order
pharmacy
provider”
is
defined
19
in
the
bill.
20
The
bill
applies
to
PBMs
that
manage
a
health
carrier’s
21
prescription
drug
benefit
in
the
state
on
or
after
the
22
effective
date
of
the
bill.
23
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