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| 1 | 1 | 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 TLSB 1831YH (2) 91 nls/ko | |
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| 3 | 3 | H.F. 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 persons 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 persons health benefit plans 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 persons 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 carriers prescription 33 drug benefit in the state on or after the effective date of 34 this Act. 35 -1- LSB 1831YH (2) 91 nls/ko 1/ 2 | |
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| 5 | 5 | H.F. 213 EXPLANATION 1 The inclusion of this explanation does not constitute agreement with 2 the explanations 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 persons 8 health benefit plan in accordance with the plans 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 persons 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 carriers 21 prescription drug benefit in the state on or after the 22 effective date of the bill. 23 -2- LSB 1831YH (2) 91 nls/ko 2/ 2 |