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2022 Iowa Legislative Session Summary

The 2022 Iowa Legislative Session will be one for the record books with PBM legislation being the very last piece of business considered by both chambers. Review the good, the bad, lessons learned and next steps for 2023.

The 2022 Iowa Legislative Session will be one for the record books with Pharmacy Benefit Manager (PBM) legislation being the very last piece of business considered by both chambers. Like any legislative session, there were some solid wins but also some disappointments. IPA's advocacy team monitored more than 32 individual bills this session on topics including a pharmacist's professional autonomy, vaccines, opioids, professional regulation, off-label prescribing and COVID-19.

Click here for a summary of the PBM bill, IPA's top legislative priority.



  • All bills that would limit a pharmacist's professional autonomy, such as in the case of off-label treatments for COVID-19, did not advance.
  • IPA was able to push the Board of Pharmacy's pharmacy practice bill across the finish line. This bill allows for nurses to practice pursuant to the orders of a pharmacist.
  • PBM legislation (HF 2384) was unanimously approved by both chambers. The State Senate has been the roadblock to PBM reform, and passing a bill through that chamber is a positive step. Legislators in both chambers stayed late into the night to consider PBM reform as the last piece of business.
  • IPA's grassroots was loud, strong and a primary reason the Senate considered PBM reform this session.
  • Key legislator supporters, including Senator Klimesh, Representative Best and Representative Jacoby, stood and voiced support for stronger PBM reform during the House and Senate debates.
  • What protections were included in the final bill?
    • The final enrolled bill can be found here.
    • The bill as passed cleans up language pursuant to the previous 8th Circuit and Rutledge Supreme Court decisions, providing oversight authority by the Iowa Insurance Division.
    • The bill prohibits clawbacks from pharmacies and patients to PBMs.
    • The bill includes MAC list transparency provisions.
    • The bill prohibits PBMs from reimbursing Iowa pharmacies lower than their own affiliate pharmacies. 


  • IPA's PBM reform legislation was significantly watered down in the State Senate despite having strong bipartisan support.
  • IPA worked with stakeholders on a bill to secure protections in the 340B programs. This legislation did not advance.


  • The Insurance Lobby continues to have a strong influence on Senate leadership.
  • Fighting until the end for pro-patient and pro-pharmacy policy puts IPA in a strong position to build on our momentum in the future.
  • Beyond insurance and PBM lobbyists, many other businesses and employers opposed the PBM bill, for fear it would raise their health insurance premiums. These are opportunities to educate and build relationships outside of the legislative process.


  • IPA will work closely with the Iowa Insurance Division on rulemaking to implement PBM legislation.
  • IPA is meeting with stakeholders to advance our priorities related to PBM reform.
  • IPA will work with grassroots to continue to advocate for meaningful PBM reform.
  • IPA will seek to educate other stakeholders, such as business and industry, on the importance of PBM reform.


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