Bill
HSB 99
HF 852 requires health plans and PBMs to notify pharmacies 60 days before restrictions, offer participation on identical terms, and inform consumers about participating pharmacies.
Status and background
- Introduced: January 29, 2025
- Originally labeled HSB 99, relating to pharmacy benefits managers (PBMs), pharmacies, and prescription drugs with applicability provisions
- Committee activity: Subcommittee and committee proceedings in early 2025
- Subcommittee: January 29, 2025; meeting February 5, 2025
- Subcommittee recommendation: February 5, 2025
- Committee vote: February 11, 2025, Yeas 23, Nays 0
- Committee report: February 11, 2025 (recommending passage)
- Status update: March 7, 2025, committee report approving the bill and renumbering it as HF 852
- This document reflects the introduced text and the actions to date; HF 852 is the renumbered version moving forward
Purpose and intent
- The bill aims to regulate how health plans, PBMs, and third-party payors manage pharmacy participation and network access
- It seeks to ensure transparency and nondiscrimination in network participation, with a focus on timely notification, uniform reimbursement terms, and consumer information
Key provisions (as introduced)
- Notice and participation obligations for health benefit plan restrictions:
- When a third-party payor imposes a restriction on participating pharmacies within the plan’s geographic coverage area, the payor must:
- Notify in writing all pharmacies within that geographic area
- Offer each affected pharmacy the opportunity to participate in the health benefit plan
- Provide this opportunity at least 60 days before the restriction takes effect
- Ensure all pharmacies in the geographic area are eligible to participate under identical reimbursement terms for dispensing prescription drugs and providing pharmacy services
- Consumer information requirement:
- The third-party payor must inform covered persons of the names and locations of all pharmacies participating in the health benefit plan as providers of pharmacy services and prescription drugs
- Pharmacy transparency and conduct:
- A participating pharmacy may announce its participation in the health benefit plan to customers
- Enforcement and compliance:
- The Commissioner shall not certify a PBM or license an insurance producer that is not in compliance with these provisions
- Injunctive relief available for violations: A covered person or pharmacy harmed by a violation may seek to enjoin its continuation
- Applicability and exclusions:
- The section does not apply to an entity that owns and operates its own facility, employs or contracts with health care personnel, and dispenses drugs to employees and dependents enrolled in the entity’s health plan
- The exemption does not apply when the entity contracts with an outside pharmacy or group to provide prescription drugs and services to the entity’s employees and dependents enrolled in the entity’s plan
- Legislative cross-reference:
- Sec. 4 adds a new subsection (-3-) to Section 510B.8, Code 2025
Who is affected
- Health benefit plans and third-party payors (including PBMs)
- Participating and prospective pharmacies within a plan’s geographic coverage area
- Covered persons (patients) who receive prescriptions through the plan
- Insurance producers and PBMs (subject to licensure/certification by the state)
Timeline and procedural notes
- Introduced and referred to Commerce (January 29, 2025)
- Subcommittee: January 29, 2025; meeting February 5, 2025
- Subcommittee recommendation: February 5, 2025
- Committee vote and passage: February 11, 2025 (Yeas 23, Nays 0)
- Committee report and renumbering: March 7, 2025 (renumbered to HF 852)
Impact considerations
- Expected benefits: Increased transparency for plan networks, reduced discriminatory or restricted access to pharmacy participation, clearer consumer information, and stronger enforcement against noncompliance
- Potential costs: Administrative burden for payors to issue notices and maintain uniform terms; possible changes to contracting and reimbursement practices for PBMs and pharmacies
Overall, the bill seeks to promote fair access to network pharmacies, align reimbursement terms across participating pharmacies, and strengthen enforcement to protect consumers and providers.
Compiled from official sources — confirm details with the bill’s official record.
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