Hunter
05/13/25
The Iowa legislature sent a bill to Governor Kim Reynolds’ desk that would prevent third-party health care companies from profiting off of prescription drugs.
The Gazette reports that pharmacy benefit managers, known as PBM’s, currently keep the difference between what they pay the pharmacies and what they charge the insurance companies. The legislation would require PBMs to use a “pass-through” pricing model, where the amount paid to the pharmacies would be the same charged to the plan sponsors. The PBM’s would be compensated through administrative fees.
Among other provisions, the PBMs would be required to reimburse small pharmacies the same as the national or Iowa average reimbursement, and could no longer limit an individual from selecting a pharmacy or pharmacist of their choice.
Pharmacists say they are selling many prescriptions at a loss because the PBM’s reimburse them less than it costs them to acquire the drug.
The Iowa Pharmacy Association issued a statement about the bill, saying it aims to protect patient choice, level the playing field and ensure fair reimbursement for pharmacies.
Critics of the bill fear the administrative fee of $10.68 the bill requires PBM’s to pay small pharmacies will lead to higher costs for plan customers.