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

Bicameral Patients before Monopolies Act reintroduced

On May 13, bipartisan lawmakers in the House and Senate reintroduced the Patients Before Monopolies (PBM) Act (S.4509/H.R.8779), legislation that would prohibit common ownership of PBMs, insurers, and pharmacies. Sponsored by Sens. Warren (D-MA) and Josh Hawley (R-MO) alongside Reps. Diana Harshbarger (R-TN) and Jake Auchincloss (D-MA), the bill would require impacted organizations to divest […]
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June 10, 2026

EGWP marketplace medicaid Medicare

legislation

CMS announces ePA acceleration initiative, democrats seek to repeal WISeR Model

The Centers for Medicare & Medicaid Services (CMS) is advancing its electronic prior authorization (ePA) efforts through a newly established Electronic Prior Authorization Acceleration initiative to address key challenges and drive solutions ahead of 2027 requirements. To date, 29 health care organizations – including health systems, electronic health record developers, physician practices, networks, and digital health […]
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June 10, 2026

EGWP marketplace medicaid Medicare

legislation

Tri-Departments release fertility excepted benefits proposed rule

On May 10, the Departments of Labor, HHS, and Treasury (the Departments) issued a proposed rule that would create a new category of limited excepted benefits to allow employers to offer stand-alone fertility benefits to their employees, similar to dental, vision, and other supplemental coverage. Benefits would be limited to fertility-related items and services for […]
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June 10, 2026

marketplace medicaid

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