Iowa SSB1074 regulates pharmacy benefits managers, ensuring fair reimbursement and prohibiting certain practices.

Iowa SSB1074 introduces regulations for pharmacy benefits managers (PBMs), focusing on fair reimbursement practices and prohibiting specific actions. The bill mandates that PBMs use a pass-through pricing model for prescription drug benefits, ensuring that payments to pharmacies reflect the actual cost. It prohibits PBMs from reimbursing pharmacies at rates below the national or state average acquisition cost. The bill also establishes an appeals process for pharmacies to challenge reimbursement rates, requiring PBMs to respond within seven business days.

Iowa SSB1074 regulates pharmacy benefits managers, ensuring fair reimbursement and prohibiting certain practices.

Iowa SSB1074 introduces regulations for pharmacy benefits managers (PBMs), focusing on fair reimbursement practices and prohibiting specific actions. The bill mandates that PBMs use a pass-through pricing model for prescription drug benefits, ensuring that payments to pharmacies reflect the actual cost. It prohibits PBMs from reimbursing pharmacies at rates below the national or state average acquisition cost. The bill also establishes an appeals process for pharmacies to challenge reimbursement rates, requiring PBMs to respond within seven business days.