House File 2297 - Introduced HOUSE FILE 2297 BY COMMITTEE ON COMMERCE (SUCCESSOR TO HSB 519) A BILL FOR An Act relating to the regulation of pharmacy benefit managers. 1 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 2 TLSB 5250HV (2) 85 av/nh

H.F. 2297 Section 1. Section 510B.1, Code 2014, is amended by adding 1 the following new subsection: 2 NEW SUBSECTION . 5A. “Maximum reimbursement amount” means 3 the maximum reimbursement amount for a therapeutically and 4 pharmaceutically equivalent multiple-source prescription drug 5 that is listed in the most recent edition of the publication 6 entitled approved drug products with therapeutic equivalence 7 evaluations, published by the United States food and drug 8 administration, otherwise known as the orange book. 9 Sec. 2. NEW SECTION . 510B.8 Pricing methodology for maximum 10 reimbursement amount. 11 1. The commissioner may require a pharmacy benefits manager 12 to submit information to the commissioner related to the 13 pharmacy benefit manager’s pricing methodology for maximum 14 reimbursement amount. 15 2. For purposes of the disclosure of pricing methodology, 16 maximum reimbursement amounts shall be implemented as follows: 17 a. Established for multiple source prescription drugs 18 prescribed after the expiration of any generic exclusivity 19 period. 20 b. Established for any prescription drug with at least two 21 or more A-rated therapeutically equivalent, multiple source 22 prescription drugs with a significant cost difference. 23 c. Determined using comparable prescription drug prices 24 obtained from multiple nationally recognized comprehensive data 25 sources including wholesalers, prescription drug file vendors, 26 and pharmaceutical manufacturers for prescription drugs that 27 are nationally available and available for purchase locally by 28 multiple pharmacies in the state. 29 3. For those prescription drugs to which maximum 30 reimbursement amount pricing applies, a pharmacy benefits 31 manager shall include in a contract with a pharmacy information 32 regarding which of the national compendia is used to 33 obtain pricing data used in the calculation of the maximum 34 reimbursement amount pricing and shall provide a process to 35 -1- LSB 5250HV (2) 85 av/nh 1/ 2

H.F. 2297 allow a pharmacy to comment on, contest, or appeal the maximum 1 reimbursement amount rates or maximum reimbursement amount 2 list. The right to comment on, contest, or appeal the maximum 3 reimbursement amount rates or maximum reimbursement amount list 4 shall be limited in duration and allow for retroactive payment 5 in the event that it is determined that maximum reimbursement 6 amount pricing has been applied incorrectly. 7 EXPLANATION 8 The inclusion of this explanation does not constitute agreement with 9 the explanation’s substance by the members of the general assembly. 10 This bill relates to the regulation of pharmacy benefit 11 managers. The bill authorizes the commissioner of insurance 12 to require a pharmacy benefits manager to submit information 13 to the commissioner related to the pharmacy benefit manager’s 14 pricing methodology for maximum reimbursement amount. 15 The bill provides that for purposes of the disclosure of 16 pricing methodology, a pharmacy benefits manager must use 17 maximum reimbursement amounts that meet specified criteria. 18 “Maximum reimbursement amount” is defined as the maximum 19 reimbursement amount for a therapeutically and pharmaceutically 20 equivalent multiple-source prescription drug that is listed in 21 the United States food and drug administration’s publication 22 entitled approved drug products with therapeutic equivalence 23 evaluations, otherwise known as the orange book. 24 For those prescription drugs to which maximum reimbursement 25 amount pricing applies, a pharmacy benefits manager must 26 include information in a contract with a pharmacy showing how 27 maximum reimbursement amount pricing is calculated and allowing 28 the pharmacy the opportunity to comment on, contest, or appeal 29 the maximum reimbursement amount rates and list. The contract 30 must also allow for retroactive payment if it is determined 31 that maximum reimbursement amount pricing has been applied 32 incorrectly. 33 -2- LSB 5250HV (2) 85 av/nh 2/ 2