IA HSB99

Prohibits pharmacy benefits managers (PBMs) from discriminating against pharmacies or pharmacists regarding participation, referral, reimbursement, or indemnification when operating within their license scope and applicable laws

Requires PBMs to use pass-through pricing in contracts executed, amended, or renewed on or after July 1, 2025, that apply to prescription drug benefits on or after January 1, 2026, unless spread pricing amounts are fully passed through to contracted parties

Mandates PBM reimbursement to Iowa pharmacies at no less than the national average drug acquisition cost or Iowa average acquisition cost, plus a professional dispensing fee equal to at least the Iowa Medicaid enterprise provider fee schedule amount

Prohibits PBMs from requiring covered persons to purchase prescriptions exclusively through mail order pharmacies, imposing different cost-sharing based on pharmacy choice, or unreasonably designating drugs as specialty to limit access

Establishes an appeals process allowing pharmacies to challenge reimbursement rates within 30 business days of claim submission, with PBMs required to respond within 7 business days and adjust rates for all similarly situated pharmacies if appeals are granted