IOWA SUMMARY OF EXISTING LAW

A health benefit plan, issued or renewed on or after July 1, 2018, that provides coverage for pharmacy benefits shall not require a covered individual to pay a copayment for pharmacy benefits that exceeds the pharmacy’s or pharmacist’s submitted charges. As of July 2, 2020, the House passed a bill that would, among other things, prohibit a PBM from DIR fees. As of July 2, 2020, the bill is in committee in the Senate.

Link to Existing Law: IA ST § 510B.10(2)

PRACTICAL NOTE

While this law does not apply directly to DIR fees, it would prevent post-point-of-sale clawbacks when the patient’s copayment amount is greater than the amount the pharmacy stands to retain.