1. 1. A pharmacy benefits manager shall provide a reasonable process to allow a pharmacy to appeal any matter.

2. 2. The appeals process must include all of the following:

   1. a. A dedicated telephone number at which a pharmacy may contact the pharmacy benefits manager and speak directly with an individual who is involved with the appeals process.
   2. b. A dedicated electronic mail address or internet site for the purpose of submitting an appeal directly to the pharmacy benefits manager.
   3. c. A period of no less than thirty business days after the date of a pharmacy’s initial submission of a clean claim during which the pharmacy may initiate an appeal.

3. 3. The pharmacy benefits manager shall respond to an appeal within seven business days after the date on which the pharmacy benefits manager receives the appeal.

   1. a. If the pharmacy benefits manager grants a pharmacy’s appeal related to a reimbursement rate, the pharmacy benefits manager shall do all of the following:

      1. (1) Adjust the reimbursement rate of the prescription drug that is the subject of the appeal and provide the national drug code number that the adjustment is based on to the appealing pharmacy.
      2. (2) Reverse and resubmit the claim that is the subject of the appeal.

      3. (3) Make the adjustment pursuant to subparagraph (1) applicable to all of the following:

         1. (a) Each pharmacy that is under common ownership with the pharmacy that submitted the appeal.
         2. (b) Each pharmacy in the state that demonstrates the inability to purchase the prescription drug for less than the established reimbursement rate.

   2. b. If the pharmacy benefits manager denies a pharmacy’s appeal, the pharmacy benefits manager shall do all of the following:

      1. (1) Provide the appealing pharmacy the national drug code number and the name of a wholesale distributor licensed pursuant to section 155A.17 from which the pharmacy can obtain the prescription drug at or below the reimbursement rate.
      2. (2) If the prescription drug identified by the national drug code number provided by the pharmacy benefits manager pursuant to subparagraph (1) is not available below the pharmacy acquisition cost from the wholesale distributor from whom the pharmacy purchases the majority of its prescription drugs for resale, the pharmacy benefits manager shall adjust the reimbursement rate above the appealing pharmacy’s pharmacy acquisition cost, and reverse and resubmit each claim affected by the pharmacy’s inability to procure the prescription drug at a cost that is equal to or less than the previously appealed reimbursement rate.

Section applies to pharmacy benefits managers, health carriers, third-party payors, and health benefit plans that manage a prescription drug benefit in the state on or after July 1, 2025; 2025 Acts, ch 151, §9 NEW section

2025 Acts, ch 151, §7, 9; 2025 Acts, ch 159, §15