SF 202 requires Iowa's pharmacy board to adopt rules by October 31, 2025, ensuring people who are blind, visually impaired, or have print disabilities receive accessible prescription labels, bag tags, and medical guides at no extra cost. These materials must be provided in fully accessible formats (like audio) within the same timeframe as standard labels for other patients. The rules must align with federal accessibility guidelines from a 2016 government report and include public notice about available formats. The board must report progress, recommendations, and projected costs for implementing these changes to Iowa's governor and legislature by January 1, 2026.
This bill restricts pharmacy benefits managers (PBMs) from requiring patients to use mail-order pharmacies exclusively (except for specialty drugs). It mandates that PBMs pass all prescription drug rebates directly to insurers or employers to lower premiums, and requires PBMs to pay pharmacies a $3 dispensing fee for small stores (5 or fewer locations) or pharmacies in rural "pharmacy deserts" (areas more than 30 miles from the nearest pharmacy). The bill also bans "spread pricing" in new contracts (effective 2026), where PBMs charge insurers more than they pay pharmacies for the same drug. These provisions directly affect PBMs, pharmacies, insurers, and patients seeking prescription drugs.
This bill regulates pharmacy benefits managers (PBMs) by defining and prohibiting certain pricing practices, such as "spread pricing." It mandates that patient cost-sharing for prescription drugs be reduced at the point of sale by at least 100% of any rebates received by the PBM or health carrier. The legislation also prevents PBMs from discriminating against pharmacies, limiting a patient's choice of pharmacy, or requiring exclusive use of mail-order pharmacies. These provisions directly affect PBMs, health carriers, pharmacies, and individuals covered by health plans.
SF 315, known as the "Iowa Competitive Pharmacy Benefits Managers Marketplace Act," aims to reduce prescription drug costs for public employees in self-funded state health plans. The bill mandates that the state department procure pharmacy benefits manager (PBM) services through a "reverse auction" process. This online, competitive bidding system allows PBMs to offer progressively lower prices for their services. Additionally, the department must acquire a technology platform to conduct these auctions and perform detailed, line-by-line audits of PBM claims to ensure contract compliance. The first PBM contract awarded through this new system is scheduled to take effect on January 1, 2026.
HF 4 requires healthcare providers to submit claims for reimbursement to a patient's primary health insurance plan first, before submitting to any secondary plans. It also mandates that primary health plans must provide a copy of the "explanation of benefits" (EOB) to the patient, their representative, or a secondary plan within 30 days of a request. The bill directly affects patients, healthcare providers, and health insurance companies by standardizing claim submission order and improving access to EOB documentation. These provisions aim to streamline billing processes and reduce administrative delays for covered individuals. The bill is procedural, focusing on claim handling rules rather than altering health coverage benefits.
This bill allows Iowa pharmacists to order, administer, and dispense point-of-care HIV tests and HIV preventive drugs (pre-exposure or post-exposure prophylaxis) under statewide protocols developed with the health department. It directly affects pharmacists, patients seeking rapid HIV testing or prevention services, and health insurance plans. The key mechanism requires health insurance plans to cover these pharmacist-provided services, even if their standard policies exclude pharmacists, as long as the services follow the approved protocols. The bill defines key terms like "HIV-related test" and "health benefit plan" to clarify implementation.
SF 188 requires most health insurance plans in Iowa to cover contraceptive drugs, devices, and services without cost-sharing (like copays or deductibles), provided the plan covers other prescription drugs or services. It prohibits insurers from denying coverage, reducing benefits, or penalizing providers for offering contraceptive care, and defines "medical need" to allow doctors to recommend specific contraceptives without extra costs. The law applies to individual and group health plans (including those for public employees) issued or renewed on or after January 1, 2026, but excludes dental, vision, and short-term insurance. Insurers must clearly disclose contraceptive coverage details on their websites and via mail upon request.
HF 213 limits pharmacy benefits managers (PBMs) in Iowa by requiring that payments made by health plan members for prescriptions count toward their deductible. It prohibits PBMs from charging different fees based on which pharmacy a member uses or blocking members from filling prescriptions at any in-state pharmacy that accepts their plan’s terms. The bill also bans PBMs from forcing members to use mail-order pharmacies exclusively for prescription drugs. These changes directly affect PBMs, pharmacies, and health plan members in Iowa, applying to PBMs managing prescription drug benefits in the state after the bill’s effective date.
This bill requires Iowa pharmacy inspectors to give nonsterile compounding pharmacies three opportunities to fix safety violations found during inspections. First, the pharmacist in charge must be notified of the issue; if uncorrected within 30-90 days, they receive instruction; if still uncorrected after another 30-90 days, mandatory education is mandated. If the pharmacy fails to correct the violation after these steps, the state board may impose a single $500 fine (adjusted for inflation annually). The bill directly affects all Iowa pharmacies compounding nonsterile medications, focusing on ensuring compliance with national pharmacy safety standards (USP General Chapter 795).
SF 209 requires most health insurance plans in Iowa to cap out-of-pocket costs for prescription insulin at $25 per prescription (for up to a 31-day supply). It directly affects people with diabetes who have insurance covering insulin, limiting their cost-sharing for four types: rapid-acting, short-acting, intermediate-acting, and long-acting insulin. The bill sets this $25 maximum for plans issued or renewed after January 1, 2026, while excluding certain insurance types like Medicare supplements. Insurers may lower costs below $25 but cannot exceed this cap for covered insulin drugs.
