The Iowa Senate recently passed Senate File 383 (“Bill”), which contains a critical “Any Willing Provider Law component, and if enacted, would be a serious development for Iowa pharmacies. If the Bill becomes law, it will prevent pharmacy benefit managers (“PBMs”) from denying a pharmacy from participating in a health benefit plan if the pharmacy meets the “terms and requirements.” In addition, the Bill seeks to address significant issues, such as inadequate reimbursement rates for independent pharmacies, which have led to devastating financial losses and pharmacy closures in the state. For the Bill to become law, it must still pass the Iowa House of Representatives and receive the signature of Governor Kim Reynolds.
The Bill has the support of Iowa’s independent pharmacies. In February 2025, the Iowa Pharmacy Association, along with over 180 pharmacists and pharmacy students, lobbied for the Bill at the Iowa Capitol. They argued that the PBM model forces local pharmacies to operate at a loss, limits patient choice and drives pharmacy closures.
Key Provisions of the Iowa PBM Reform Bill
Prohibiting PBMs from Limiting Patients’ Choice of Pharmacies:
Health benefit plans cannot prevent or limit a covered person from choosing any participating pharmacy or pharmacist, nor can they impose financial incentives or penalties (such as varying copayments, coinsurance, reimbursement rates, or promoting one pharmacy over another) that would influence the person’s choice.
Ensuring Equal Access for Contracting Pharmacies:
Pharmacies and pharmacists cannot be denied the right to participate as contract providers in a health benefit plan if they agree to provide services according to the plan’s terms and reimbursement rates. If a PBM attempted to terminate a pharmacy or deny a pharmacy from having access to a pharmacy network, the pharmacy may be able to challenge the denial.
Prohibiting Additional or Excessive Credentialing Requirements:
Health benefit plans cannot require pharmacies or pharmacists to complete additional courses, accreditations, certifications, or credentialing that are inconsistent with, more stringent than, or in addition to state licensing or certification requirements.
Preventing Higher Copayments or Smaller Reimbursements Based on Pharmacy Choice:
PBMs would be barred from charging higher copayments or providing smaller reimbursements depending on the pharmacy selected by the patient. Pharmacies could leverage this portion of the Bill to challenge these PBM tactics which often interfere with an independent pharmacy’s ability to compete with PBM-affiliated pharmacies.
Ensuring Patients Are Not Required to Use Mail-Order Pharmacies:
Patients would have the freedom to choose between local and mail-order pharmacies, without being mandated to use the latter.
Requiring PBMs to Reimburse Pharmacies at Fair Rates:
PBMs would be required to reimburse pharmacies at rates not less than the national average drug acquisition cost plus a professional dispensing fee. Pharmacies would be able to more effectively challenge their reimbursement if the Bill is enacted.
Establishing a Structured Appeals Process for Pharmacies:
A formal process would be set up for pharmacies to challenge PBM decisions, ensuring transparency and fairness.
Strengthening State and Federal PBM Regulation
Iowa’s “Any Willing Provider Law”, if enacted, would serve as a state-based corollary to Medicare’s existing “Any Willing Provider Law”. The two laws combined would offer a dual layer of protection for Iowa pharmacies. Currently, Medicare’s “Any Willing Provider Law” requires PBMs to admit willing, qualified Medicare providers that meet the terms and conditions of participation under the prescription drug plan. Similarly, Iowa’s “Any Willing Provider Law” would require PBMs to admit any provider, in this context a pharmacy provider, willing to accept the PBMs’ reasonable terms and conditions governing participation in the PBMs’ pharmacy networks. This dual protection would limit PBMs’ ability to improperly deny or terminate pharmacies from their networks.
Since the monumental U.S. Supreme Court decision Rutledge v. PCMA, several states, similar to Iowa’s attempt here, have taken steps to enact reasonable PBM regulations with the understanding from Rutledge that reasonable regulations will not violate certain federal laws (e.g., ERISA) and will be upheld.
Why This Bill Matters
The passage of Senate File 383 would be a major step toward PBM accountability and pharmacy reimbursement reform in Iowa. It aims to create a fairer and more transparent system for pharmacies and patients, though it faces opposition from those concerned about potential cost increases. For this Bill to become law, it is crucial for stakeholders, including patients, pharmacists, and concerned citizens, to join those who have already advocated for the Bill by participating in the legislative process. By engaging in the process, supporters can help ensure that the Bill gains the necessary momentum to be passed into law, ultimately leading to a fairer and more transparent pharmaceutical system in Iowa.
How Frier Levitt Can Help Pharmacies with PBM Issues
Frier Levitt represents pharmacies nationwide in in challenging PBM audits, network access denials, reimbursement(including DIR fees and MAC reimbursement) and other critical aspects of the pharmacy-PBM relationship. Our attorneys have deep experience navigating state and federal PBM laws and advocating for pharmacy rights.
If your pharmacy is facing unfair PBM practices or needs legal guidance on state pharmacy laws, contact Frier Levitt to speak with a knowledgeable PBM litigation and pharmacy law attorney.
Frier Levitt provides strategic, industry-focused legal counsel tailored to your needs. Contact our team today to learn how we can help you.
