Senate
File
563
-
Enrolled
Senate
File
563
AN
ACT
RELATING
TO
PHARMACY
BENEFIT
MANAGERS
AND
INFORMATION
RELATED
TO
THE
MANAGEMENT
OF
PRESCRIPTION
DRUG
BENEFITS,
AND
INCLUDING
APPLICABILITY
PROVISIONS.
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
Section
1.
NEW
SECTION
.
510C.1
Definitions.
As
used
in
this
chapter
unless
the
context
otherwise
requires:
1.
“Administrative
fees”
means
a
fee
or
payment,
other
than
a
rebate,
under
a
contract
between
a
pharmacy
benefit
manager
and
a
pharmaceutical
drug
manufacturer
in
connection
with
the
pharmacy
benefit
manager’s
management
of
a
health
carrier’s
prescription
drug
benefit,
that
is
paid
by
a
pharmaceutical
drug
manufacturer
to
a
pharmacy
benefit
manager
or
is
retained
by
the
pharmacy
benefit
manager.
2.
“Aggregate
retained
rebate
percentage”
means
the
percentage
of
all
rebates
received
by
a
pharmacy
benefit
manager
that
is
not
passed
on
to
the
pharmacy
benefit
manager’s
health
carrier
clients.
3.
“Commissioner”
means
the
commissioner
of
insurance.
4.
“Covered
person”
means
the
same
as
defined
in
section
514J.102.
5.
“Formulary”
means
a
complete
list
of
prescription
drugs
eligible
for
coverage
under
a
health
benefit
plan.
6.
“Health
benefit
plan”
means
the
same
as
defined
in
section
514J.102.
Senate
File
563,
p.
2
7.
“Health
carrier”
means
the
same
as
defined
in
section
514J.102.
8.
“Health
carrier
administrative
service
fee”
means
a
fee
or
payment
under
a
contract
between
a
pharmacy
benefit
manager
and
a
health
carrier
in
connection
with
the
pharmacy
benefit
manager’s
administration
of
the
health
carrier’s
prescription
drug
benefit
that
is
paid
by
a
health
carrier
to
a
pharmacy
benefit
manager
or
is
otherwise
retained
by
a
pharmacy
benefit
manager.
9.
“Pharmacy
benefit
manager”
means
a
person
who,
pursuant
to
a
contract
or
other
relationship
with
a
health
carrier,
either
directly
or
through
an
intermediary,
manages
a
prescription
drug
benefit
provided
by
the
health
carrier.
10.
“Prescription
drug
benefit”
means
a
health
benefit
plan
providing
for
third-party
payment
or
prepayment
for
prescription
drugs.
11.
“Rebate”
means
all
discounts
and
other
negotiated
price
concessions
paid
directly
or
indirectly
by
a
pharmaceutical
manufacturer
or
other
entity,
other
than
a
covered
person,
in
the
prescription
drug
supply
chain
to
a
pharmacy
benefit
manager,
and
which
may
be
based
on
any
of
the
following:
a.
A
pharmaceutical
manufacturer’s
list
price
for
a
prescription
drug.
b.
Utilization.
c.
To
maintain
a
net
price
for
a
prescription
drug
for
a
specified
period
of
time
for
the
pharmacy
benefit
manager
in
the
event
the
pharmaceutical
manufacturer’s
list
price
increases.
d.
Reasonable
estimates
of
the
volume
of
a
prescribed
drug
that
will
be
dispensed
by
a
pharmacy
to
covered
persons.
Sec.
2.
NEW
SECTION
.
510C.2
Annual
report
to
the
commissioner.
1.
Each
pharmacy
benefit
manager
shall
provide
a
report
annually
by
February
15
to
the
commissioner
that
contains
all
of
the
following
information
regarding
prescription
drug
benefits
provided
to
covered
persons
of
each
health
carrier
with
whom
the
pharmacy
manager
has
contracted
during
the
prior
calendar
year:
a.
The
aggregate
dollar
amount
of
all
rebates
received
by
Senate
File
563,
p.
3
the
pharmacy
benefit
manager.
b.
The
aggregate
dollar
amount
of
all
administrative
fees
received
by
the
pharmacy
benefit
manager.
c.
The
aggregate
dollar
amount
of
all
health
carrier
administrative
service
fees
received
by
the
pharmacy
benefit
manager.
d.
The
aggregate
dollar
amount
of
all
rebates
received
by
the
pharmacy
benefit
manager
that
the
pharmacy
benefit
manager
did
not
pass
through
to
the
health
carrier.
e.
The
aggregate
amount
of
all
administrative
fees
received
by
the
pharmacy
benefit
manager
that
the
pharmacy
benefit
manager
did
not
pass
through
to
the
health
carrier.
f.
The
aggregate
retained
rebate
percentage
as
calculated
by
dividing
the
dollar
amount
in
paragraph
“d”
by
the
dollar
amount
in
paragraph
“a”
.
g.
Across
all
health
carrier
clients
with
whom
the
pharmacy
manager
was
contracted,
the
highest
and
the
lowest
aggregate
retained
rebate
percentages.
2.
a.
A
pharmacy
benefit
manager
shall
provide
the
information
pursuant
to
subsection
1
to
the
commissioner
in
a
format
approved
by
the
commissioner
that
does
not
directly
or
indirectly
disclose
any
of
the
following:
(1)
The
identity
of
a
specific
health
carrier.
(2)
The
price
charged
by
a
specific
pharmaceutical
manufacturer
for
a
specific
prescription
drug
or
for
a
class
of
prescription
drugs.
(3)
The
amount
of
rebates
provided
for
a
specific
prescription
drug
or
class
of
prescription
drugs.
b.
Information
provided
under
this
section
by
a
pharmacy
benefit
manager
to
the
commissioner
that
may
reveal
the
identity
of
a
specific
health
carrier,
the
price
charged
by
a
specific
pharmaceutical
manufacturer
for
a
specific
prescription
drug
or
class
of
prescription
drugs,
or
the
amount
of
rebates
provided
for
a
specific
prescription
drug
or
class
of
prescription
drugs
shall
be
considered
a
confidential
record
and
be
recognized
and
protected
as
a
trade
secret
pursuant
to
section
22.7,
subsection
3.
3.
The
commissioner
shall
publish,
within
sixty
calendar
days
of
receipt,
the
nonconfidential
information
received
by
Senate
File
563,
p.
4
the
commissioner
on
a
publicly
accessible
internet
site.
The
information
shall
be
made
available
to
the
public
in
a
format
that
complies
with
subsection
2,
paragraph
“a”
.
Sec.
3.
NEW
SECTION
.
510C.3
Rules.
The
commissioner
of
insurance
shall
adopt
rules
pursuant
to
chapter
17A
as
necessary
to
administer
this
chapter.
Sec.
4.
NEW
SECTION
.
510C.4
Enforcement.
The
commissioner
may
take
any
action
within
the
commissioner’s
authority
to
enforce
compliance
with
this
chapter.
Sec.
5.
NEW
SECTION
.
510C.5
Applicability.
This
chapter
is
applicable
to
a
health
benefit
plan
that
is
delivered,
issued
for
delivery,
continued,
or
renewed
in
this
state
on
or
after
January
1,
2019.
______________________________
CHARLES
SCHNEIDER
President
of
the
Senate
______________________________
LINDA
UPMEYER
Speaker
of
the
House
I
hereby
certify
that
this
bill
originated
in
the
Senate
and
is
known
as
Senate
File
563,
Eighty-eighth
General
Assembly.
______________________________
W.
CHARLES
SMITHSON
Secretary
of
the
Senate
Approved
_______________,
2019
______________________________
KIM
REYNOLDS
Governor