Iowa Governor Signs Law to Tighten PBM Oversight

July 9, 2025

EGWP marketplace medicaid Medicare

Gov. Kim Reynolds (R) recently signed a law that restricts PBMs from steering patients to preferred pharmacies and bans the use of mandatory mail order provisions. The legislation requires PBMs to reimburse independent pharmacies at the same rate as PBMs pay their affiliated pharmacies and to pay higher dispensing fees for prescriptions.

The governor included a signing message which cites vertical integration, one-sided contracts, and pharmacy closures among the reasons for choosing to sign the measure into law. The governor also indicated she will pursue the use of a “reverse auction” when PBMs bid on the state employee business this summer.

legislation

Virginia and Hawaii Introduce PDAB Legislation

The Virginia Senate introduced a bill to establish a Prescription Drug Affordability Board (PDAB) to review drugs with a wholesale acquisition cost (WAC) of $60,000 or more per year or a WAC increase of $3,000 or more in any 12-month period. For drugs deemed to cause an affordability challenge, the legislation authorizes the PDAB to […]
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February 12, 2026

EGWP marketplace medicaid Medicare

Solutions

AHIP Shares Update on Plan Progress to Simplify Prior Authorization

AHIP shared progress on the voluntary, multi-year commitments made by AHIP, BCBSA, and leading health plans (including Cigna Healthcare) to streamline and simplify prior authorization. Health plans serving nearly 270 million Americans are participating in this initiative. The 2026 commitments took effect on Jan. 1 and include: reducing the scope of claims subject to prior […]
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February 12, 2026

EGWP marketplace medicaid Medicare

legislation

DOL Issues Proposed Rule on Improving Transparency into PBM Fees

Pursuant to President Trump’s Executive Order “Lowering Drug Prices by Once Again Putting Americans First,” the Department of Labor’s (DOL’s) Employee Benefits Security Administration (EBSA) issued a proposed rule that would require providers of PBM services and affiliated entities of brokerage and consulting services to disclose direct and indirect compensation to their self-funded ERISA fiduciary […]
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February 12, 2026

EGWP marketplace medicaid Medicare

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