PBM Bill FAQ
In conclusion of the 2022 Legislative Session, IPA has created an FAQ resource to answer member questions regarding the PBM bill (HF 2384).
What provisions were removed from the PBM bill?
- The following provisions were removed by the House:
- Pharmacy’s ability to decline to fill prescriptions paid below acquisition cost
- Reimbursement floor utilizing cost plus reimbursement methodology based on NADAC and Iowa Medicaid cost of dispensing surveys
- Requirement that manufacturer rebates benefit the patient at point-of-sale
- The following provisions were removed by the Senate:
- Any willing pharmacy network provisions
- Appeals section allowing pharmacies to appeal claims paid below acquisition cost and requiring PBMs to adjust reimbursement accordingly
- Requirement that patient payments apply to their deductible
- Prohibition of charging patients different cost-sharing based on their pharmacy of choice
- Anti-mandatory mail order
- Co-pay card patient provisions
- The short answer is no.
- The bill as passed by the House was scored by the Legislative Services Agency (LSA) at $10.2 million in the Fiscal Note. A final Senate amendment drafted by Senator Mike Klimesh would have allowed the state and other self-funded plans to maintain exclusive mail order arrangements, which were scored at $2.5 million for the state, bringing the fiscal note down under $8 million.
- In the final weeks of session, many business groups raised concerns about their ability to secure specialty drug discounts through exclusive pharmacy arrangements. IPA worked with stakeholders and Senator Mike Klimesh on an amendment that would have addressed the concerns about premium impact from these discounts while maintaining the other protections contained in the bill, but we were unable to gain support of Senate leadership.
- Late on the last day of session, IPA met with Senators Klimesh, Edler, and Costello to review what we believed to be a final amendment to the bill. IPA agreed with that amendment moving forward to the floor. Upon learning that the appeals section was subsequently removed from the agreed upon amendment, IPA changed its official registration to “against.”
- You can read more in our statement found here.