All Roll Calls
Yes: 132 • No: 98
IowaSF 38391st General Assembly (2025–2026)SenateWALLET
A bill for an act relating to pharmacy benefits managers, pharmacies, prescription drugs, and pharmacy services administrative organizations, and including applicability provisions. (Formerly SSB 1074.) Effective date: 07/01/2025. Applicability date: 07/01/2025.
Sponsored By: COMMITTEE ON HEALTH AND HUMAN SERVICES
Signed by Governor
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Bill Overview
Analyzed Economic Effects
6 provisions identified: 5 benefits, 0 costs, 1 mixed.
Fair pay and appeals for pharmacies
Beginning July 1, 2025, PBMs must pay at least the NADAC price per unit (or WAC if NADAC is unavailable) plus a $10.68 dispensing fee per prescription. PBMs cannot pay an Iowa pharmacy less per unit than they pay their own PBM affiliate for the same drug. PBMs must offer a clear appeals process with a phone line and portal; pharmacies get at least 30 business days to appeal a clean claim, PBMs must answer in seven business days, and must fix underpayments statewide when an appeal is granted.
You choose your pharmacy, not PBMs
Beginning July 1, 2025, PBMs cannot force mail-order or limit your choice of in‑network pharmacy. They cannot charge you a higher copay or fee based only on which pharmacy you use. PBMs also cannot label a drug as “specialty” just to block fills at local in‑network pharmacies. If you or your pharmacy are harmed by a bad specialty label, you can file a complaint with the insurance commissioner.
Stop unfair network rules for pharmacies
Beginning July 1, 2025, PBMs and insurers cannot discriminate against licensed pharmacies or pharmacists or demand extra credentials beyond state licensing. If a payor limits pharmacy participation in an area, it must give all local pharmacies 60 days’ written notice and let eligible ones join on the same pay terms.
PBMs must pass all drug rebates
Beginning July 1, 2025, PBMs must send 100% of drug rebates to the insurer or to the employer plan sponsor as allowed by federal law. For contracts signed or changed on or after July 1, 2025, and that apply on or after January 1, 2026, PBM contracts must use pass‑through pricing and honor required rebate and fee distribution terms. These terms override any conflicting contract language.
Your drug payments count toward deductible
Beginning July 1, 2025, what you pay for prescriptions counts toward your plan’s cost‑sharing and deductible. For HSA‑eligible high‑deductible plans, amounts count only after you meet the plan’s minimum deductible. Preventive drugs still count before the deductible, per federal rules.
Stronger oversight of PBMs and plans
Starting July 1, 2025, the law defines key terms like NADAC, pass‑through pricing, retail pharmacy, and specialty drug. The insurance commissioner cannot certify a PBM or license a producer that violates these rules, and injured patients or pharmacies can sue to stop violations. These rules apply to PBMs, health carriers, third‑party payors, and health plans that manage drug benefits in Iowa on or after July 1, 2025.
Sponsors & Cosponsors
Sponsor
COMMITTEE ON HEALTH AND HUMAN SERVICES
Affiliation unavailable
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
legislature vote • 5/12/2025
Motion to suspend rules for immediate consideration of amendment H-1324
Yes: 21 • No: 69
House vote • 5/12/2025
Passed House
Yes: 75 • No: 15
Senate vote • 4/28/2025
Passed Senate
Yes: 36 • No: 14
Actions Timeline
Signed by Governor.
6/11/2025GovernorFiscal note.
6/6/2025legislatureExplanation of vote.
5/20/2025legislatureReported correctly enrolled, signed by President and Speaker, and sent to Governor.
5/19/2025SenateMessage from House.
5/12/2025HouseImmediate message.
5/12/2025legislaturePassed House, yeas 75, nays 15.
5/12/2025HouseMotion to suspend rules failed.
5/12/2025legislatureMotion to suspend rules for immediate consideration of amendment H-1324, yeas 21, nays 69.
5/12/2025legislaturePoint of order raised on amendment H-1324, ruled not germane.
5/12/2025legislatureAmendment H-1324 filed.
5/12/2025legislatureAmendment H-1302 filed, withdrawn.
5/12/2025legislatureSubstituted for HF 852.
5/12/2025legislatureFiscal note.
5/7/2025legislatureFiscal note.
5/6/2025legislatureRead first time, passed on file.
4/30/2025legislatureMessage from Senate.
4/29/2025SenateImmediate message.
4/28/2025legislaturePassed Senate, yeas 36, nays 14.
4/28/2025SenateAmendment S-3104 out of order.
4/28/2025legislatureAmendment S-3138 adopted.
4/28/2025legislatureAmendment S-3139 filed, lost.
4/28/2025legislatureAmendment S-3138 filed.
4/28/2025legislatureDeferred.
4/28/2025legislatureAmendment S-3104 filed.
4/16/2025legislature
Bill Text
As Introduced
Enrolled
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