Bill Text: IA SF2204 | 2013-2014 | 85th General Assembly | Introduced
Bill Title: A bill for an act relating to the regulation of pharmacy benefits managers. (Formerly SSB 3087.)
Spectrum: Committee Bill
Status: (Introduced - Dead) 2014-03-04 - Withdrawn. S.J. 465. [SF2204 Detail]
Download: Iowa-2013-SF2204-Introduced.html
Senate
File
2204
-
Introduced
SENATE
FILE
2204
BY
COMMITTEE
ON
COMMERCE
(SUCCESSOR
TO
SSB
3087)
A
BILL
FOR
An
Act
relating
to
the
regulation
of
pharmacy
benefits
1
managers.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
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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.
Section
510B.2,
Code
2014,
is
amended
by
adding
the
10
following
new
unnumbered
paragraph:
11
NEW
UNNUMBERED
PARAGRAPH
.
As
a
condition
of
complying
with
12
this
section
regarding
certification,
a
pharmacy
benefits
13
manager
shall
enter
into
and
maintain
an
agreement
with
14
the
commissioner
setting
out
the
terms
of
disclosure
of
15
information,
as
deemed
necessary
by
the
commissioner,
relating
16
to
rebates
received
by
the
pharmacy
benefits
manager.
17
Sec.
3.
NEW
SECTION
.
510B.8
Pricing
methodology
for
maximum
18
reimbursement
amount.
19
1.
The
commissioner
may
require
a
pharmacy
benefits
manager
20
to
submit
information
to
the
commissioner
related
to
the
21
pharmacy
benefits
manager’s
pricing
methodology
for
maximum
22
reimbursement
amount.
23
2.
For
purposes
of
the
disclosure
of
pricing
methodology,
24
maximum
reimbursement
amounts
shall
be
implemented
as
follows:
25
a.
Established
for
multiple
source
prescription
drugs
26
prescribed
after
the
expiration
of
any
generic
exclusivity
27
period.
28
b.
Established
for
any
prescription
drug
with
at
least
two
29
or
more
A-rated
therapeutically
equivalent,
multiple
source
30
prescription
drugs
with
a
significant
cost
difference.
31
c.
Determined
using
comparable
prescription
drug
prices
32
obtained
from
multiple
nationally
recognized
comprehensive
data
33
sources
including
wholesalers,
prescription
drug
file
vendors,
34
and
pharmaceutical
manufacturers
for
prescription
drugs
that
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are
nationally
available
and
available
for
purchase
locally
by
1
multiple
pharmacies
in
the
state.
2
3.
For
those
prescription
drugs
to
which
maximum
3
reimbursement
amount
pricing
applies,
a
pharmacy
benefits
4
manager
shall
include
in
a
contract
with
a
pharmacy
information
5
regarding
which
of
the
national
compendia
is
used
to
6
obtain
pricing
data
used
in
the
calculation
of
the
maximum
7
reimbursement
amount
pricing
and
shall
provide
a
process
to
8
allow
a
pharmacy
to
comment
on,
contest,
or
appeal
the
maximum
9
reimbursement
amount
rates
or
maximum
reimbursement
amount
10
list.
The
right
to
comment
on,
contest,
or
appeal
the
maximum
11
reimbursement
amount
rates
or
maximum
reimbursement
amount
list
12
shall
be
limited
in
duration
and
allow
for
retroactive
payment
13
in
the
event
that
it
is
determined
that
maximum
reimbursement
14
amount
pricing
has
been
applied
incorrectly.
15
Sec.
4.
COMPLIANCE
PERIOD
FOR
DISCLOSURE
AGREEMENTS.
In
16
order
to
comply
with
the
certification
and
disclosure
17
requirements
of
section
510B.2,
as
amended
in
this
Act,
a
18
pharmacy
benefits
manager
shall
have
one
hundred
eighty
days
19
after
the
effective
date
of
this
Act
within
which
to
enter
20
into
an
agreement
with
the
commissioner
regarding
disclosure
21
of
rebate
information.
22
EXPLANATION
23
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
24
the
explanation’s
substance
by
the
members
of
the
general
assembly.
25
This
bill
relates
to
the
regulation
of
pharmacy
benefits
26
managers.
The
bill
authorizes
the
commissioner
of
insurance
27
to
require
a
pharmacy
benefits
manager
to
submit
information
28
to
the
commissioner
related
to
the
pharmacy
benefits
manager’s
29
pricing
methodology
for
maximum
reimbursement
amounts
for
30
prescription
drugs.
“Maximum
reimbursement
amount”
is
defined
31
as
the
maximum
reimbursement
amount
for
a
therapeutically
32
and
pharmaceutically
equivalent
multiple-source
prescription
33
drug
that
is
listed
in
the
United
States
food
and
drug
34
administration’s
publication
entitled
approved
drug
products
35
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with
therapeutic
equivalence
evaluations,
otherwise
known
as
1
the
orange
book.
2
For
those
prescription
drugs
to
which
maximum
reimbursement
3
amount
pricing
applies,
a
pharmacy
benefits
manager
must
4
include
information
in
a
contract
with
a
pharmacy
showing
how
5
maximum
reimbursement
amount
pricing
is
calculated
and
allowing
6
the
pharmacy
the
opportunity
to
comment
on,
contest,
or
appeal
7
the
maximum
reimbursement
amount
rates
and
list.
The
contract
8
must
also
allow
for
retroactive
payment
if
it
is
determined
9
that
maximum
reimbursement
amount
pricing
has
been
applied
10
incorrectly.
11
The
bill
also
allows
the
commissioner
to
implement
the
12
information
submission
requirements
in
relation
to
generic
13
exclusivity,
therapeutically
equivalent
drugs,
and
multiple
14
drug
manufacturers,
wholesalers,
and
vendors.
15
The
bill
provides
that
pharmacy
benefits
managers
must,
16
within
six
months
of
the
effective
date
of
the
bill,
enter
into
17
an
agreement
with
the
commissioner
relating
to
disclosure
of
18
rebates
received
by
the
pharmacy
benefits
managers.
19
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