IA| Iowa Insurance Division Bulletin 25-06 provides updated guidance on the implementation of SF 383, addressing prohibited unfair and deceptive practices by Pharmacy Benefit Managers (PBMs) in Iowa, with new rules reinforcing pricing transparency, equitable reimbursement, and protections for pharmacies and consumers as of July 1, 2025
Key Points:
- SF 383 requires all PBMs to reimburse Iowa retail pharmacies at not less than the National Average Drug Acquisition Cost (NADAC) plus a mandatory dispensing fee of $10.68, alongside enhanced appeal rights and oversight of reimbursement calculations and pharmacy contracts.
- The law mandates that 100% of manufacturer rebates received by PBMs must be passed on to third-party payors to reduce consumer premiums, and cost-sharing rules have been tightened to ensure covered persons’ contributions are fairly applied at the point of sale.
- The Division warns against opaque pricing, exclusionary reimbursement networks favoring PBM-affiliated pharmacies, and non-negotiable contract terms, confirming that violations of SF 383 also constitute unfair or deceptive trade practices under Iowa law and are subject to enforcement.
