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Amendments › HF 729

Amendment H-1221 to HF 729

Relating to pharmacy benefits managers, pharmacies, and prescription drug benefits, and including applicability provisions

Never voted on

Filed March 16, 2021 in the House by

What it changes

  1. Page 1, line 5, by striking “subsection 2” and inserting “subsection 3”
  2. Page 1, line 33, after “514J.102.” by inserting ““Health carrier” does not include the department of human services, or a managed care organization acting pursuant to a contract with the department of human services to administer the medical assistance program under chapter 249A or the healthy and well kids in Iowa (hawk-i) program under chapter 514I.”
  3. Page 1, after line 33 by inserting: “___. “Incentive-based program” means a program by which a pharmacy benefits manager or a health carrier pays a pharmacy based on the pharmacy’s performance in relation to objective, patient-focused criteria.”
  4. Page 3, after line 4 by inserting: “___. “Specialty drug” means a prescription drug that a health carrier has designated as a specialty drug and that has either of the following characteristics: a. The United States food and drug administration has designated the prescription drug an orphan drug. b. The manufacturer of the prescription drug, or the United States food and drug administration, restricts distribution of the prescription drug to a limited number of distributors.”
  5. Page 3, after line 14 by inserting: “Sec. ___. Section 510B.3, subsection 2, Code 2021, is amended to read as follows:
  6. A pharmacy benefits manager, as an agent or vendor of an insurance company, is subject to the commissioner’s authority to conduct an examination pursuant to chapter 507 . The procedures set forth in chapter 507 regarding examination reports examinations shall apply to an examination of a pharmacy benefits manager under this chapter .”
  7. Page 4, line 30, after “
  8. ” by inserting “a.”
  9. Page 4, after line 33 by inserting: “b. Notwithstanding paragraph “a” , a pharmacy located in the state may be prohibited from participating in a specialty drug pharmacy network even if the pharmacy accepts the same terms and conditions as the pharmacy benefits manager imposes on the pharmacies in the specialty drug pharmacy network.”
  10. Page 5, line 21, after “
  11. ” by inserting “a.”
  12. Page 5, line 24, by striking “at least” and inserting “other pharmacies in the same network.”
  13. Page 5, by striking lines 25 and
  15. Page 5, before line 27 by inserting: “b. Notwithstanding paragraph “a” , a covered person may be prohibited from filling a prescription drug order for a specialty drug at certain pharmacies located in the state even if the pharmacy accepts the same terms and conditions as the pharmacy benefits manager imposes on at least one of the pharmacy networks that the pharmacy benefits manager has established in the state for filling the same type of specialty drug prescription drug orders.”
  16. Page 5, line 27, after “
  17. ” by inserting “a.”
  18. Page 5, after line 30 by inserting: “b. Notwithstanding paragraph “a” , a pharmacy benefits manager may impose different cost-sharing or additional fees on a covered person based on the pharmacy at which the covered person fills the covered person’s prescription drug order if the cost-sharing or additional fees are related to a prescription drug order for a specialty drug, or to an incentive-based program.”
  19. Page 5, line 31, after “
  20. ” by inserting “a.”
  21. Page 5, after line 35 by inserting: “b. If a pharmacy declines to dispense a prescription drug to a covered person under paragraph “a” , the pharmacy shall dispense a substitute prescription drug if permitted pursuant to section 510B.6.”
  22. Page 6, line 2, by striking “drug” and inserting “drug, other than a specialty drug,”
  23. Page 7, line 2, before “A” by inserting “
  24. ”
  25. Page 7, line 6, after “pharmacy” by inserting “, unless the difference in the reimbursement amount is due to an incentive-based program in which the pharmacy is participating”
  26. Page 7, after line 8 by inserting: “
  27. Notwithstanding subsection 1, a pharmacy benefits manager may reimburse any pharmacy located in the state in an amount less than the amount that the pharmacy benefits manager reimburses a pharmacy benefits manager affiliate for dispensing the same specialty drug as dispensed by the pharmacy.”
  28. Page 7, line 14, by striking “audit” and inserting “audit, the claim has been fraudulently submitted, or the claim is duplicative of a claim that has already been paid”
  29. Page 8, by striking lines 11 through
  31. Page 8, by striking lines 15 through 31 and inserting “appeal, the pharmacy benefits manager shall provide the appealing pharmacy the national drug code number and the name of a wholesale distributor licensed pursuant to section 155A.17 from which the pharmacy can obtain the prescription drug at or below the maximum allowable cost.”
  32. By striking page 9, line 7, through page 10, line
  34. Page 10, after line 25 by inserting: “Sec. ___. NEW SECTION . 510B.13 Applicability. This chapter shall not apply to a health benefit plan that provides a prescription drug benefit for Medicare beneficiaries under Medicare part D, 42 U.S.C. §1395w-101 et seq., and that is administered by a pharmacy benefits manager.”
  35. Page 10, line 26, by striking “510B.3” and inserting “510B.10”
  36. By renumbering, redesignating, and correcting internal references as necessary.

Official amendment (PDF) · In the Bill Book