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Amendments

Amendment S-3139

Failed · April 28, 2025Strike everything: replaces the whole bill

Filed April 28, 2025 in the Senate by Sen. Sarah Trone Garriott (D)

What it changes

  1. By striking page 1, line 2, through page 10, line 10, and inserting: “
  2. By striking everything after the enacting clause and inserting: “Section
  3. Section 510B.1, Code 2025, is amended by adding the following new subsections: NEW SUBSECTION . 16A. “Pharmacy desert” means a geographic area with a single pharmacy located at least thirty miles from the nearest pharmacy. NEW SUBSECTION . 21A. “Specialty drug” means a drug used to treat chronic and complex or rare medical conditions and that requires special handling or administration, provider care coordination, or patient education that cannot be provided by a nonspecialty pharmacy or pharmacist. NEW SUBSECTION . 21B. “Spread pricing” means a pharmacy benefits manager charges a third-party payor more for prescription drugs dispensed to a covered person than the amount the pharmacy benefits manager reimburses the pharmacy for dispensing the prescription drugs to a covered person. Sec.
  4. NEW SECTION . 510B.4B Prohibited conduct.
  5. a. A pharmacy benefits manager shall not do any of the following: (1) Where a pharmacy or pharmacist has agreed to participate in a covered person’s health benefit plan, prohibit or limit the covered person from selecting a pharmacy or pharmacist of the covered person’s choice. (2) Deny a pharmacy or pharmacist the right to participate as a contract provider under a health benefit plan if the pharmacy or pharmacist agrees to provide pharmacy services that meet the terms and requirements of the health benefit plan and the pharmacy or pharmacist agrees to the terms of reimbursement set forth by the third-party payor. (3) Impose upon a pharmacy or pharmacist, as a condition of participation in a third-party payor network, any course -1- S 3138.1787 (3) 91 nls/ko 1/ 5 of study, accreditation, certification, or credentialing that is inconsistent with, more stringent than, or in addition to state requirements for licensure or certification, and the administrative rules adopted by the board of pharmacy. (4) Require a covered person, as a condition of payment or reimbursement, to purchase pharmacy services, including prescription drugs, exclusively through a mail order pharmacy. b. This subsection shall not apply to a specialty drug.
  6. a. If a third-party payor providing reimbursement to covered persons for prescription drugs restricts pharmacy participation, the third-party payor shall notify, in writing, all pharmacies within the geographical coverage area of the health benefit plan restriction, and offer the pharmacies the opportunity to participate in the health benefit plan at least sixty days prior to the effective date of the health benefit plan restriction. All pharmacies in the geographical coverage area of the health benefit plan shall be eligible to participate under identical reimbursement terms for providing pharmacy services and prescription drugs. This paragraph shall not apply to a specialty drug. b. The third-party payor shall inform covered persons of the names and locations of all pharmacies participating in the health benefit plan as providers of pharmacy services and prescription drugs. c. A participating pharmacy shall be entitled to announce the pharmacy’s participation in the health benefit plan to the pharmacy’s customers.
  7. The commissioner shall not certify a pharmacy benefits manager or license an insurance producer that is not in compliance with this section.
  8. A covered person or pharmacy injured by a violation of this section may maintain a cause of action to enjoin the continuation of the violation.
  9. This section shall not apply to an entity that owns and operates the entity’s own facility, employs or contracts -2- S 3138.1787 (3) 91 nls/ko 2/ 5 with physicians, pharmacists, nurses, or other health care personnel, and that dispenses prescription drugs from the entity’s pharmacy to the entity’s employees and dependents enrolled in the entity’s health benefit plan, except that this section shall apply to an entity otherwise excluded that contracts with an outside pharmacy or group of pharmacies to provide prescription drugs and services to the entity’s employees and dependents enrolled in the entity’s health benefit plan. Sec.
  10. Section 510B.8, Code 2025, is amended by adding the following new subsection: NEW SUBSECTION .
  11. One hundred percent of all rebates received by a pharmacy benefits manager shall be passed through to the health carrier or employer plan sponsor for the purpose of reducing premiums. Sec.
  12. Section 510B.8B, Code 2025, is amended to read as follows: 510B.8B Pharmacy benefits manager affiliates managers —— reimbursement.
  13. A pharmacy benefits manager shall not 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 prescription drug as dispensed by the pharmacy. The reimbursement amount shall be calculated on a per unit basis based on the same generic product identifier or generic code number.
  14. For a prescription filled at a pharmacy with five or less locations, a pharmacy benefits manager shall reimburse the pharmacy or pharmacist a professional dispensing fee in the amount of ten dollars and sixty-eight cents.
  15. For a prescription filled at a pharmacy with six or more locations, and that has any location located in a pharmacy desert, a pharmacy benefits manager shall reimburse the pharmacy located in a pharmacy desert a professional dispensing fee in the amount of ten dollars and sixty-eight cents. -3- S 3138.1787 (3) 91 nls/ko 3/ 5 Sec.
  16. NEW SECTION . 510B.8D Pharmacy benefits manager contracts —— spread pricing. All contracts executed, amended, adjusted, or renewed on or after July 1, 2025, that apply to prescription drug benefits on or after January 1, 2026, between a pharmacy benefits manager and a third-party payor, or between a person and a third-party payor, shall prohibit the practice of spread pricing. Sec.
  17. PHARMACY SERVICES ADMINISTRATIVE ORGANIZATIONS AND WHOLESALE DISTRIBUTION OF PRESCRIPTION DRUGS —— REPORT.
  18. 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.
  19. 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 -4- S 3138.1787 (3) 91 nls/ko 4/ 5 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.”
  20. 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.””

Official amendment (PDF) · In the Bill Book