Amendment S-3104 to SF 383

Filed April 16, 2025 in the Senate by Sen. Mike Klimesh (R)

What it changes

1. Page 2, by striking lines 12 and 13 and inserting “reduction in reimbursement for services, a promotion of one participating pharmacy over another, or comparing the reimbursement rates of a pharmacy against mail order pharmacy reimbursement rates.”
2. Page 2, line 19, after “payor” by inserting “for similarly classified pharmacies”
3. Page 4, by striking lines 19 through 31 and inserting: “NEW SUBSECTION .
4. For the purpose of reducing premiums, one hundred percent of all rebates received by a pharmacy benefits manager shall be passed through to the health carrier, or to the employee plan sponsor as permitted by the federal Employee Retirement Income Security Act of 1974, 29 U.S.C. §1001, et seq.”
5. Page 5, after line 5 by inserting: “NEW SUBSECTION .
6. If a covered person’s policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses qualifies as a high-deductible health plan under section 223 of the Internal Revenue Code, and a copayment, coinsurance, or deductible paid by the covered person as a cost-sharing requirement under this chapter would result in the covered person becoming ineligible for a health savings account associated with the covered person’s high-deductible health plan, subsection 5 shall apply only after the covered person satisfies the covered person’s minimum deductible, except for items or services determined to be preventive care under section 223(c)(2)(C) of the Internal Revenue Code.”
7. By striking page 5, line 34, through page 6, line 1, and inserting “report to the commissioner, in a form approved by the commissioner, of all drugs reimbursed below the national average drug acquisition cost, and all drugs reimbursed ten percent or more above the national”
8. Page 6, after line 21 by inserting: “e. Upon the request of the commissioner, a pharmacy benefits manager shall provide the commissioner with any additional information pursuant to paragraph “b” in a form and manner prescribed by the commissioner in a manner that does not publicly disclose the information, and that complies with the federal Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191. Requested information may include but is not limited to health benefit plan, manufacturer, or market specific information.”
9. By striking page 6, line 31, through page 7, line 4, and inserting “pricing.”
10. Page 7, line 5, by striking “c.” and inserting “b.”
11. Page 7, by striking lines 19 through 21 and inserting “process to allow a pharmacy to appeal any matter.”
12. Page 8, line 1, after “appeal” by inserting “related to a reimbursement rate”
13. Page 8, by striking lines 16 through 18 and inserting: “b. If the pharmacy benefits manager denies a pharmacy’s appeal, the pharmacy benefits manager shall do all of the following: (1) 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 reimbursement rate. (2) If the prescription drug identified by the national drug code number provided by the pharmacy benefits manager pursuant to subparagraph (1) is not available below the pharmacy acquisition cost from the wholesale distributor from whom the pharmacy purchases the majority of its prescription drugs for resale, the pharmacy benefits manager shall adjust the reimbursement rate above the appealing pharmacy’s pharmacy acquisition cost, and reverse and resubmit each claim affected by the pharmacy’s inability to procure the prescription drug at a cost that is equal to or less than the previously appealed reimbursement rate. Sec. ___. PHARMACY SERVICES ADMINISTRATIVE ORGANIZATIONS AND WHOLESALE DISTRIBUTION OF PRESCRIPTION DRUGS —— REPORT.
14. Before January 1, 2026, the commissioner of insurance, or the commissioner of insurance’s designee, shall review pharmacy services administrative organizations and the wholesale distribution of prescription drugs, and submit a report to the general assembly containing the commissioner’s findings and recommendations. The report shall include, at a minimum, all of the following: a. A description and analysis of the prescription drug wholesale distribution supply chain, including the market concentration for the wholesale distribution of prescription drugs, margins in the wholesale distribution of prescription drugs, and the competition in the wholesale distribution of prescription drugs. b. A description of the role that pharmacy services administrative organizations serve in the prescription drug supply chain. c. A description and analysis of the relationships between pharmacy services administrative organizations, prescription drug wholesalers, and retail pharmacies, including but not limited to standard contracting terms, fees charged to pharmacies, and contractual restrictions and limitations applicable to retail pharmacies.
15. a. The commissioner of insurance shall provide the information pursuant to subsection 1 to the general assembly in a format that does not publicly disclose any of the following: (1) The identity of a specific pharmacy services administrative organization or prescription drug wholesaler. (2) The price charged to a specific pharmacy for a specific prescription drug. b. Information provided under this section by the commissioner to the general assembly that may reveal the identity of a specific pharmacy services administrative organization or prescription drug wholesaler, or the price charged to a specific pharmacy for a specific prescription drug, shall be considered a confidential record.”
16. Page 8, line 20, by striking “managers” and inserting “managers, health carriers, third-party payors, and health benefit plans”
17. Title page, by striking lines 1 and 2 and inserting “An Act relating to pharmacy benefits managers, pharmacies, prescription drugs, and pharmacy services administrative organizations, and including applicability provisions.”
18. By renumbering as necessary.

Official amendment (PDF) · In the Bill Book