Bill Text: IA SF2231 | 2021-2022 | 89th General Assembly | Introduced

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Bill Title: A bill for an act relating to pharmacy benefits managers, pharmacies, and prescription drug benefits, and including applicability provisions.(Formerly SF 2092.)

Spectrum: Committee Bill

Status: (Introduced - Dead) 2022-05-24 - Withdrawn. S.J. 929. [SF2231 Detail]

Download: Iowa-2021-SF2231-Introduced.html

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Senate File 2231 - Introduced
SENATE FILE 2231
BY COMMITTEE ON COMMERCE
(SUCCESSOR TO SF 2092)
A BILL FOR
An Act relating to pharmacy benefits managers, pharmacies, and
prescription drug benefits, and including applicability
provisions.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
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Section 1. Section 505.26, subsection 1, paragraph b, Code
2022, is amended to read as follows:
b. “Pharmacy benefits manager” means the same as defined in
section 510B.1 510C.1 .
Sec. 2. Section 507B.4, subsection 3, Code 2022, is amended
by adding the following new paragraph:
NEW PARAGRAPH . t. Pharmacy benefits managers. Any
violation of chapter 510B by a pharmacy benefits manager.
Sec. 3. Section 510B.1, Code 2022, is amended by striking
the section and inserting in lieu thereof the following:
510B.1 Definitions.
As used in this chapter, unless the context otherwise
requires:
1. “Clean claim” means a claim that has no defect or
impropriety, including a lack of any required substantiating
documentation, or other circumstances requiring special
treatment, that prevents timely payment from being made on the
claim.
2. “Commissioner ” means the commissioner of insurance.
3. “Cost-sharing” means any coverage limit, copayment,
coinsurance, deductible, or other out-of-pocket cost obligation
imposed by a health benefit plan on a covered person.
4. “Covered person” means a policyholder, subscriber, or
other person participating in a health benefit plan that has
a prescription drug benefit managed by a pharmacy benefits
manager.
5. “Health benefit plan” means the same as defined in
section 514J.102.
6. “Health care professional” means the same as defined in
section 514J.102.
7. “Health carrier” means the same as defined in section
514J.102.
8. “Maximum allowable cost” means the maximum amount that a
pharmacy will be reimbursed by a pharmacy benefits manager or a
health carrier for a generic drug, brand-name drug, biologic
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product, or other prescription drug, and that may include any
of the following:
a. Average acquisition cost.
b. National average acquisition cost.
c. Average manufacturer price.
d. Average wholesale price.
e. Brand effective rate.
f. Generic effective rate.
g. Discount indexing.
h. Federal upper limits.
i. Wholesale acquisition cost.
j. Any other term used by a pharmacy benefits manager or a
health carrier to establish reimbursement rates for a pharmacy.
9. “Maximum allowable cost list” means a list of
prescription drugs that includes the maximum allowable cost
for each prescription drug and that is used, directly or
indirectly, by a pharmacy benefits manager.
10. “Pharmacist” means the same as defined in section
155A.3.
11. “Pharmacy” means the same as defined in section 155A.3.
12. “Pharmacy acquisition cost” means the cost to a pharmacy
for a prescription drug as invoiced by a wholesale distributor.
13. “Pharmacy benefits manager” means the same as defined
in section 510C.1.
14. “Pharmacy benefits manager affiliate” means a pharmacy or
a pharmacist that directly or indirectly through one or more
intermediaries, owns or controls, is owned and controlled by,
or is under common ownership or control of, a pharmacy benefits
manager.
15. “Pharmacy network” or “network” means pharmacies that
have contracted with a pharmacy benefits manager to dispense
or sell prescription drugs to covered persons of a health
benefit plan for which the pharmacy benefits manager manages
the prescription drug benefit.
16. “Prescription drug” means the same as defined in section
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155A.3.
17. “Prescription drug benefit” means the same as defined
in section 510C.1.
18. “Prescription drug order” means the same as defined in
section 155A.3.
19. “Rebate” means the same as defined in section 510C.1.
20. “Wholesale distributor” means the same as defined in
section 155A.3.
Sec. 4. Section 510B.4, Code 2022, is amended to read as
follows:
510B.4 Performance of duties —— good faith —— conflict of
interest.
1. A pharmacy benefits manager shall perform the pharmacy
benefits manager’s duties exercising exercise good faith and
fair dealing in the performance of its the pharmacy benefits
manager’s contractual obligations toward the covered entity a
health carrier .
2. A pharmacy benefits manager shall notify the covered
entity a health carrier in writing of any activity, policy,
practice ownership interest, or affiliation of the pharmacy
benefits manager that presents any conflict of interest.
3. a. A pharmacy benefits manager shall owe a fiduciary
duty to each health carrier for whom the pharmacy benefits
manager manages a prescription drug benefit provided by the
health carrier, and shall discharge its duties in accordance
with applicable state and federal law.
b. A health carrier shall owe a fiduciary duty to each
covered person participating in a health benefit plan offered
or issued by the health carrier, and the health carrier shall
discharge its duties in accordance with applicable state and
federal law.
4. A pharmacy benefits manager, health carrier, or health
benefit plan shall not discriminate against a pharmacy
or a pharmacist with respect to participation, referral,
reimbursement of a covered service, or indemnification if a
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pharmacist is acting within the scope of the pharmacist’s
license.
Sec. 5. Section 510B.5, Code 2022, is amended to read as
follows:
510B.5 Contacting covered individual persons —— requirements.
A pharmacy benefits manager, unless authorized pursuant to
the terms of its contract with a covered entity health carrier ,
shall not contact any covered individual person without
the express written permission of the covered entity health
carrier .
Sec. 6. Section 510B.6, Code 2022, is amended to read as
follows:
510B.6 Dispensing of substitute Substitute prescription drug
for prescribed drug drugs .
1. The following provisions shall apply when if a pharmacy
benefits manager requests the dispensing of a substitute
prescription drug for a prescribed drug to prescribed for a
covered individual person :
a. The pharmacy benefits manager may request the
substitution of a lower priced generic and therapeutically
equivalent prescription drug for a higher priced prescribed
prescription drug.
b. If the substitute prescription drug’s net cost to the
covered individual person or covered entity to the health
carrier exceeds the cost of the prescribed prescription drug
originally prescribed for the covered person , the substitution
shall be made only for medical reasons that benefit the covered
individual person .
2. A pharmacy benefits manager shall obtain the approval of
the prescribing practitioner health care professional prior to
requesting any substitution under this section .
3. A pharmacy benefits manager shall not substitute an
equivalent prescription drug contrary to a prescription drug
order that prohibits a substitution.
Sec. 7. Section 510B.7, Code 2022, is amended by striking
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the section and inserting in lieu thereof the following:
510B.7 Pharmacy networks.
1. A pharmacy located in the state shall not be prohibited
from participating in a pharmacy network provided that the
pharmacy accepts the same terms and conditions as the pharmacy
benefits manager imposes on the pharmacies in the network.
2. A pharmacy benefits manager shall not assess, charge, or
collect any form of remuneration that passes from a pharmacy
or a pharmacist in a pharmacy network to the pharmacy benefits
manager including but not limited to claim processing fees,
performance-based fees, network participation fees, or
accreditation fees.
Sec. 8. Section 510B.8, Code 2022, is amended by striking
the section and inserting in lieu thereof the following:
510B.8 Prescription drugs —— point of sale.
1. A covered person shall not be required to make a
cost-sharing payment at the point of sale for a prescription
drug in an amount that exceeds the maximum allowable cost for
that drug at the pharmacy at which the covered person fills the
covered person’s prescription drug order.
2. A pharmacy benefits manager shall not prohibit a pharmacy
from disclosing the availability of a lower-cost prescription
drug option to a covered person, or from selling a lower-cost
prescription drug option to a covered person.
3. Any amount paid by a covered person for a prescription
drug purchased pursuant to this section shall be applied to any
deductible imposed by the covered person’s health benefit plan
in accordance with the health benefit plan coverage documents.
4. A covered person shall not be prohibited from filling
a prescription drug order at any pharmacy located in the
state provided that the pharmacy accepts the same terms and
conditions as the covered person’s health benefit plan.
5. A pharmacy benefits manager shall not impose different
cost-sharing or additional fees on a covered person based on
the pharmacy at which the covered person fills the covered
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person’s prescription drug order.
6. A pharmacy benefits manager shall not require a covered
person, as a condition of payment or reimbursement, to purchase
pharmacy services, including prescription drugs, exclusively
through a mail-order pharmacy.
7. a. A covered person’s cost-sharing for a prescription
drug shall be calculated at the point-of-sale based on a price
that is reduced by an amount equal to at least one hundred
percent of all rebates that have been received, or that will be
received, by the health carrier or a pharmacy benefits manager
in connection with the dispensing or administration of the
prescription drug.
b. A health carrier shall not be precluded from decreasing
a covered person’s cost-sharing by an amount greater than the
covered person’s cost-sharing as calculated under paragraph
“a” .
8. A pharmacy benefits manager shall include any amount
paid by a covered person, or by any other person on behalf of
a covered person, when calculating the covered person’s total
contribution toward the covered person’s cost-sharing.
9. A pharmacy may decline to dispense a prescription drug to
a covered person if, as a result of the maximum allowable cost
list to which the pharmacy is subject, the pharmacy will be
reimbursed less for the prescription drug than the pharmacy’s
acquisition cost.
Sec. 9. NEW SECTION . 510B.8A Maximum allowable cost lists.
1. Prior to placement of a particular prescription drug on a
maximum allowable cost list, a pharmacy benefits manager shall
ensure that all of the following requirements are met:
a. The particular prescription drug must be listed as
therapeutically and pharmaceutically equivalent in the most
recent edition of the publication entitled “Approved Drug
Products with Therapeutic Equivalence Evaluations”, published
by the United States food and drug administration, otherwise
known as the orange book.
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b. The particular prescription drug must not be obsolete or
temporarily unavailable.
c. The particular prescription drug must be available for
purchase, without limitations, by all pharmacies in the state
from a national or regional wholesale distributor that is
licensed in the state.
2. For each maximum allowable cost list that a pharmacy
benefits manager uses in the state, the pharmacy benefits
manager shall do all of the following:
a. Provide each pharmacy in a pharmacy network reasonable
access to the maximum allowable cost list to which the pharmacy
is subject.
b. Update the maximum allowable cost list within seven
calendar days from the date of an increase of ten percent or
more in the pharmacy acquisition cost of a prescription drug on
the list by one or more wholesale distributors doing business
in the state.
c. Update the maximum allowable cost list within seven
calendar days from the date of a change in the methodology, or
a change in the value of a variable applied in the methodology,
on which the maximum allowable cost list is based.
d. Provide a reasonable process for each pharmacy in a
pharmacy network to receive prompt notice of all changes to the
maximum allowable cost list to which the pharmacy is subject.
Sec. 10. NEW SECTION . 510B.8B Reimbursement.
1. A pharmacy benefits manager shall not reimburse a
pharmacy or pharmacist for a prescription drug in an amount
less than the national average drug acquisition cost for the
prescription drug on the date that the drug is administered or
dispensed.
2. In addition to the reimbursement required under
subsection 1, a pharmacy benefits manager shall reimburse the
pharmacy or pharmacist a professional dispensing fee that is
no less than the pharmacy dispensing fee published in the Iowa
Medicaid enterprise provider fee schedule on the date that the
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prescription drug is administered or dispensed.
Sec. 11. NEW SECTION . 510B.8C Pharmacy benefits manager
affiliates —— reimbursement.
A pharmacy benefits manager shall not reimburse any pharmacy
located in the state in an amount less than the amount that
the pharmacy benefits manager reimburses a pharmacy benefits
manager affiliate for dispensing the same prescription drug
as dispensed by the pharmacy. The reimbursement amount shall
be calculated on a per unit basis based on the same generic
product identifier or generic code number.
Sec. 12. NEW SECTION . 510B.8D Clean claims.
After the date of receipt of a clean claim submitted by a
pharmacy in a pharmacy network, a pharmacy benefits manager
shall not retroactively reduce payment on the claim, either
directly or indirectly, except if the claim is found not to be
a clean claim during the course of a routine audit.
Sec. 13. NEW SECTION . 510B.8E Appeals and disputes.
1. A pharmacy benefits manager shall provide a reasonable
process to allow a pharmacy to appeal a maximum allowable cost,
or a reimbursement made under a maximum allowable cost list,
for a specific prescription drug for any of the following
reasons:
a. The pharmacy benefits manager violated section 510B.8A.
b. The maximum allowable cost is below the pharmacy
acquisition cost.
2. The appeal process must include all of the following:
a. A dedicated telephone number at which a pharmacy may
contact the pharmacy benefits manager and speak directly with
an individual involved in the appeal process.
b. A dedicated electronic mail address or internet site for
the purpose of submitting an appeal directly to the pharmacy
benefits manager.
c. A period of at least seven business days after the date
of a pharmacy’s initial submission of a clean claim during
which the pharmacy may initiate an appeal.
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3. A pharmacy benefits manager shall respond to an appeal
within seven business days after the date on which the pharmacy
benefits manager receives the appeal.
a. If the pharmacy benefits manager grants a pharmacy’s
appeal, the pharmacy benefits manager shall do all of the
following:
(1) Adjust the maximum allowable cost of the prescription
drug that is the subject of the appeal and provide the national
drug code number that the adjustment is based on to the
appealing pharmacy.
(2) Permit the appealing pharmacy to reverse and rebill the
claim that is the subject of the appeal.
(3) Make the adjustment pursuant to subparagraph (1)
applicable to each pharmacy in the state subject to the same
maximum allowable cost list as the appealing pharmacy.
b. If the pharmacy benefits manager denies a pharmacy’s
appeal, the pharmacy benefits manager shall do all of the
following:
(1) Provide the appealing pharmacy the national drug
code number and the name of a wholesale distributor licensed
pursuant to section 155A.17 from which the pharmacy can obtain
the prescription drug at or below the maximum allowable cost.
(2) If the prescription drug identified by the national drug
code number provided by the pharmacy benefits manager pursuant
to subparagraph (1) is not available below the pharmacy
acquisition cost from the wholesale distributor from whom the
pharmacy purchases the majority of its prescription drugs for
resale, the pharmacy benefits manager shall adjust the maximum
allowable cost list above the appealing pharmacy’s pharmacy
acquisition cost, and permit the pharmacy to reverse and rebill
each claim affected by the pharmacy’s inability to procure the
prescription drug at a cost that is equal to or less than the
previously appealed maximum allowable cost.
Sec. 14. Section 510B.9, Code 2022, is amended to read as
follows:
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510B.9 Submission, approval, and use of prior Prior
authorization form .
A pharmacy benefits manager shall file with and have
approved by the commissioner a single prior authorization
form as provided in section 505.26 comply with all applicable
prior authorization requirements pursuant to section 505.26 .
A pharmacy benefits manager shall use the single prior
authorization form as provided in section 505.26 .
Sec. 15. Section 510B.10, Code 2022, is amended by striking
the section and inserting in lieu thereof the following:
510B.10 Enforcement.
1. The commissioner shall take any enforcement action under
the commissioner’s authority to enforce compliance with this
chapter.
2. After notice and hearing, the commissioner may issue any
order or impose any penalty pursuant to section 507B.7, and may
suspend or revoke a pharmacy benefits manager’s certificate
of registration as a third-party administrator upon a finding
that the pharmacy benefits manager violated this chapter,
or any applicable requirements pertaining to third-party
administrators under chapter 510.
3. A pharmacy benefits manager, as an agent or vendor of a
health carrier, is subject to the commissioner’s authority to
conduct an examination pursuant to chapter 507. The procedures
set forth in chapter 507 regarding examination reports shall
apply to an examination of a pharmacy benefits manager under
this chapter.
4. A pharmacy benefits manager is subject to the
commissioner’s authority to conduct a proceeding pursuant
to chapter 507B. The procedures set forth in chapter 507B
regarding proceedings shall apply to a proceeding related to a
pharmacy benefits manager under this chapter.
5. A pharmacy benefits manager is subject to the
commissioner’s authority to conduct an examination, audit,
or inspection pursuant to chapter 510 for third-party
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administrators. The procedures set forth in chapter 510 for
third-party administrators shall apply to an examination,
audit, or inspection of a pharmacy benefits manager under this
chapter.
6. If the commissioner conducts an examination of a pharmacy
benefits manager under chapter 507; a proceeding under chapter
507B; or an examination, audit, or inspection under chapter
510, all information received from the pharmacy benefits
manager, and all notes, work papers, or other documents related
to the examination, proceeding, audit, or inspection shall
be confidential records pursuant to chapter 22 and shall be
accorded the same confidentiality as notes, work papers,
investigatory materials, or other documents related to the
examination of an insurer as provided in section 507.14.
7. A violation of this chapter shall be an unfair or
deceptive act or practice in the business of insurance pursuant
to section 507B.4, subsection 3.
Sec. 16. NEW SECTION . 510B.11 Rules.
The commissioner shall adopt rules pursuant to chapter 17A
to administer this chapter.
Sec. 17. NEW SECTION . 510B.12 Severability.
If a provision of this chapter or its application to any
person or circumstance is held invalid, the invalidity does
not affect other provisions or applications of this chapter
which can be given effect without the invalid provision or
application, and to this end the provisions of this chapter are
severable.
Sec. 18. REPEAL. Section 510B.3, Code 2022, is repealed.
Sec. 19. APPLICABILITY. This Act applies to pharmacy
benefits managers that manage a health carrier’s prescription
drug benefit in the state on or after the effective date of
this Act.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
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This bill relates to pharmacy benefits managers (PBM),
pharmacies, and prescription drug benefits.
The bill provides that a PBM owes a fiduciary duty to
each health carrier (carrier) for whom the PBM manages a
prescription drug benefit (drug benefit) provided by the
carrier, and shall discharge its duties in accordance with
applicable state and federal law. The bill also provides that
a carrier shall owe a fiduciary duty to each covered person
participating in a health benefit plan (benefit plan) offered
or issued by the carrier, and the carrier shall discharge
its duties in accordance with applicable state and federal
law. The bill prohibits a PBM, carrier, or benefit plan from
discriminating against a pharmacy or pharmacist with respect to
participation, referral, reimbursement of a covered service, or
indemnification if a pharmacist is acting within the scope of
the pharmacist’s license.
The bill requires a PBM to allow a pharmacy located in the
state to participate in a pharmacy network (network) provided
that the pharmacy accepts the same terms and conditions as
the PBM imposes on the pharmacies in the network. “Pharmacy
benefits manager” is defined in the bill as a person who,
pursuant to a contract or other relationship with a carrier,
either directly or through an intermediary, manages a
drug benefit provided by the carrier. “Pharmacy network”,
“pharmacist”, “pharmacy”, “prescription drug benefit”, and
“health carrier” are also defined in the bill.
The bill prohibits a PBM from assessing, charging, or
collecting any form of remuneration that passes from a pharmacy
in the network to the PBM including but not limited to claim
processing fees, performance-based fees, network participation
fees, or accreditation fees.
The bill prohibits a covered person from being required
to make a cost-sharing payment at the point-of-sale for a
prescription drug (drug) in an amount that exceeds the maximum
allowable cost (MAC) for that drug. The bill defines the MAC
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as the maximum amount that a pharmacy will be reimbursed by a
PBM or a carrier for a generic drug, brand-name drug, biologic
product, or other drug and that may include the average or
national average acquisition cost; the average manufacturer
price; the average wholesale price; the brand or generic
effective rate; discount indexing; federal upper limits;
wholesale acquisition cost; or any other term used by a PBM
or carrier to establish reimbursement rates for a pharmacy.
“Covered person” is defined in the bill.
A PBM cannot prohibit a pharmacy from disclosing the
availability of a lower-cost drug option to a covered person,
or from selling a lower-cost drug option to a covered person.
The bill requires that any amount paid by a covered person
for a drug in the circumstances detailed in the bill must
be applied to any deductible imposed by the covered person’s
health benefit plan in accordance with the plan’s coverage
documents. Under the bill, a covered person cannot be
prohibited from filling a drug order at any pharmacy located
in the state if the pharmacy accepts the same terms and
conditions as the covered person’s benefit plan. A PBM cannot
impose different cost-sharing or additional fees on a covered
person based on the pharmacy at which a covered person fills
their prescription. A PBM cannot require a covered person,
as a condition of payment or reimbursement, to purchase
pharmacy services, including drugs, exclusively through
a mail-order pharmacy. The bill requires that a covered
person’s cost-sharing for a drug shall be calculated at the
point-of-sale based on a price that is reduced by an amount
equal to at least 100 percent of all rebates that have been
received, or that will be received, by the health carrier or
a PBM in connection with the dispensing or administration of
the drug. A health carrier may decrease a covered person’s
cost-sharing by a greater amount. “Rebate” is defined in the
bill. A PBM shall include any amount paid by a covered person,
or by any other person on behalf of a covered person, when
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calculating the covered person’s total contribution toward the
covered person’s cost-sharing. “Cost-sharing” is defined in
the bill. The bill allows a pharmacy to decline to dispense
a drug to a covered person if, as a result of the maximum
allowable cost list (MACL) to which the pharmacy is subject,
the pharmacy will be reimbursed less than the pharmacy’s
acquisition cost. “Pharmacy acquisition cost” is defined in
the bill. “Maximum allowable cost list” is defined in the
bill as a list of prescription drugs that includes the MAC for
each drug and that is used, directly or indirectly, by a PBM.
“Pharmacy acquisition cost” is also defined in the bill.
The bill requires that prior to placement of a particular
drug on a MACL, a PBM must ensure that the drug is listed as
therapeutically and pharmaceutically equivalent in the most
recent edition of the “Approved Drug Products with Therapeutic
Equivalence Evaluations”, published by the United States
food and drug administration; the drug cannot be obsolete or
temporarily unavailable; and the drug must be available for
purchase by all pharmacies in the state from a national or
regional wholesale distributor that is licensed in the state.
“Wholesale distributor” is defined in the bill.
The bill requires a PBM to provide each pharmacy in a
network reasonable access to the MACL to which the pharmacy is
subject, and to update each MACL within seven calendar days
from the date of an increase of 10 percent or more in the
pharmacy acquisition cost of a drug by one or more wholesale
distributors doing business in the state. The PBM must also
update a MACL within seven calendar days from the date of a
change in the methodology, or a change in a value of a variable
applied in the methodology, on which the MACL is based. The
PBM is also required to provide a process for each pharmacy in
a network to receive prompt notice of all changes to a MACL.
The bill provides that a PBM shall not reimburse a pharmacy
or pharmacist for a drug in an amount less than the national
average drug acquisition cost for the drug on the date that
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the drug is administered or dispensed. In addition to the
reimbursement, a PBM shall reimburse the pharmacy or pharmacist
a professional dispensing fee that is no less than the pharmacy
dispensing fee published in the Iowa Medicaid enterprise
provider fee schedule on the date that the drug is administered
or dispensed.
The bill prohibits a PBM from reimbursing a pharmacy located
in the state in an amount less than the amount that the PBM
reimburses a PBM affiliate for dispensing the same drug as the
pharmacy. “Pharmacy benefits manager affiliate” is defined in
the bill.
The bill provides that after the date of receipt of a clean
claim submitted by a pharmacy, a PBM cannot retroactively
reduce payment on the claim, either directly or indirectly,
except if the claim is found not to be a clean claim during the
course of a routine audit. “Clean claim” is defined in the
bill.
The bill requires a PBM to provide a process for pharmacies
to appeal a MAC, or a reimbursement made under a MACL. The
requirements for the appeal process are detailed in the bill.
The commissioner of insurance (commissioner) is required
to take any enforcement action under the commissioner’s
authority to enforce compliance with the bill. After notice
and hearing, the commissioner may issue any order or impose
any penalty pursuant to Code section 507B.7, and may suspend
or revoke a PBM’s certificate of registration as a third-party
administrator upon a finding that the PBM violated any
requirements of the bill, or any applicable requirements
pertaining to third-party administrators under Code chapter
510.
A PBM is subject to the commissioner’s authority to conduct
an examination pursuant to Code chapter 507 and a proceeding
pursuant to Code chapter 507B. A PBM is also subject to
the commissioner’s authority to conduct an examination,
audit, or inspection pursuant to Code chapter 510. If the
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commissioner conducts an examination, a proceeding, an audit,
or an inspection, all information received from the PBM, and
all documents related to the examination, proceeding, audit, or
inspection are confidential records pursuant to Code chapter
22.
A violation of the bill is an unfair or deceptive act or
practice in the business of insurance pursuant to Code section
507B.4, for which the commissioner may issue an order or impose
a penalty.
The bill requires the commissioner to adopt rules to
administer the bill.
If a provision of the bill or its application to any person
or circumstance is held invalid, the invalidity does not affect
other provisions or applications of the bill that can be given
effect without the invalid provision or application.
The bill makes conforming changes to Code sections 510B.2,
510B.4, 510B.5, 510B.6, and 510B.9.
The bill repeals Code section 510B.3 which is replaced in
large part by new Code section 510B.10 (enforcement).
The bill applies to PBMs that manage a health carrier’s
prescription drug benefit in the state on or after the
effective date of the bill.
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