This week, both the House Commerce Subcommittee and the Senate Health and Human Services Subcommittee recommended passage of HSB 99 and SSB 1074, respectively. These companion bills relate to PBMs, pharmacies and prescriptions drugs. Among the various provisions includes patient choice of pharmacy. Also, a PBM shall not deny a pharmacy or pharmacist the right to participate as a contract provider if the pharmacy or pharmacist agrees to the terms and requirements of the plan. Additionally, a PBM shall not require a person, as a condition of payment or reimbursement, to purchase pharmacy services exclusively through a mail order pharmacy. Finally, the bill prohibits a PBM from reimbursing a pharmacy in an amount less than the National Average Drug Acquisition Cost (NADAC) or the Iowa average acquisition cost for a prescription on the date the prescription is administered or dispensed, and the PBM also must reimburse the pharmacy or pharmacist a professional dispensing fee in an amount not less than the pharmacy dispensing fee published in the Iowa Medicaid Enterprise provider fee schedule on the date the prescription is administered or dispensed.

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

With an effective date of November 27, the Insurance Division published ARC 8427C as adopted and filed emergency rule making related to timely payment of pharmacy claims.

Also in Iowa, the Insurance Division published ARC 8429C as a Notice of Intended Action. This Notice of Intent is to solicit public comment on the above emergency rulemaking; see ARC 8427C. This proposed rulemaking is related to timely payment of pharmacy claims and providing an opportunity for public comment. Written comments may to submitted to the Division no later than 4:30 pm on December 19. A public hearing will be held on December 19 from 10:00 am-11:00 am.

Finally in Iowa, the Department of Health and Human Services (HHS), Medicaid posted INFORMATIONAL LETTER NO. 2647-MC-FFS-D – January 2025 Medicaid Pharmacy Program Changes, effective January 1, 2025.

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

The Iowa Pharmacy Association’s Board of Trustees received notice from Kate Gainer that she intends to step down as CEO, effective June 2025. Plans are underway to hire a search firm and appoint a search committee.

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

The Department of Health and Human Services (HHS), Iowa Medicaid posted INFORMATIONAL LETTER NO. 2641-MC-FFS-D – Ownership and Control Disclosure (OCD) Reminder effective upon receipt.

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

The Department of Inspections Appeals and Licensing issued the Professional Health Committee – Pharmacy meeting notice for November 6, 2024, at 11:00 am. Agendas are subject to change and may be revised up to 24 hours before the start of the meeting. Please check the DIAL Public Meeting Calendar to ensure you are viewing the current version. The next meeting for the committee will take place on December 4, 2024.

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

The Department of Health and Human Services (HHS), Iowa Medicaid posted the following: 

• INFORMATIONAL LETTER NO. 2631-FFS Update Regarding Pharmacy Prior Authorization (PA)
• INFORMATIONAL LETTER NO. 2636-MC-FFS E&M Codes Rate Changes

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

The Department of Health and Human Services (HHS), Iowa Medicaid posted INFORMATIONAL LETTER NO. 2630-MC-FFS 2024 Pharmacy Dispensing Fee Increase.  Effective October 1, 2024, the Iowa Medicaid dispensing fee increased from $10.38 to $10.63 based on the 2022 Cost of Dispensing survey.

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

The Department of Health and Human Services (HHS), Iowa Medicaid posted the following: 

• INFORMATIONAL LETTER NO. 2627-MC-FFS Vaccine for Children (VFC) Program: Administration Code Update
• INFORMATIONAL LETTER NO. 2626-MC HHS Announces Winning Bidder for Iowa Health Link RFP (RFP MED-26-001)
• INFORMATIONAL LETTER NO. 2625-MC-FFS-D October 2024 Iowa Medicaid Pharmacy Program Changes

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.

The Department of Health and Human Services (HHS) announced the intent to award a Managed Care Organization (MCO) contract to Iowa Total Care. The new Iowa Medicaid contract period begins July 1, 2025, with no change in operations. This RFP and resulting contract aligns all three MCO contracts (Iowa Total Care, Molina, and Wellpoint Iowa, Inc.) to provide health care services to Iowans to the same contract cycle. All three MCO contracts will have a final contract end date of June 30, 2031.

For more information, contact NACDS’ Sandra Guckian at 703-774-4801.