Barker

Earlier today I was asked which word comes to mind when I reflect on the 2025 Legislative Session and I chose “whirlwind.” It was truly a whirlwind of activity from the time the gavel fell to open the session on a cold January morning to the time it closed the session sine die at 6:30 AM on May 15 after a grueling 22 hour session. With two key legislative deadlines prior to final adjournment, there’s a very fast past of work needed to keep priorities alive. I am proud to report that 14 bills that I sponsored or managed passed the House with 6 making it all the way to the Governor’s desk. I campaigned on being a champion for good conservative policy for all Iowans and by doing just that I was scored as a top 5 most bipartisan House Republican in the Across the Aisle Initiative preliminary report.

This session I tackled two very big lifts: ensuring rural representation on the Story County Board of Supervisors and Pharmacy Benefit Manager Reform. I was pleased to share the news of Governor Reynolds signing our county supervisor bill into law in previous newsletters.

My big news for this week is that the Iowa House passed SF 383, a strong PBM reform bill, with a vote of 75-15 on Monday! I am proud to have managed this bill across the finish line and to the Governor’s desk! Governor Reynolds has been a champion for rural healthcare access and PBM reform will preserve our pharmacy infrastructure and patient access across our state.

From my floor remarks about SF 383:

Monona. State Center. Fontanelle. These are just 3 of the more than 200 pharmacies that have closed in Iowa in the last decade, including more than 30 last year. Pharmacists are America’s most accessible healthcare providers and pharmacies are a critical component of our healthcare infrastructure in both rural and urban communities. One of the most gut wrenching decisions you can make as a pharmacist is to close the only pharmacy in a community because you know this will have a significant impact on the people and communities that you became a pharmacist to care for.

For far too long, Pharmacy Benefit Managers, powerful middlemen in the pharmaceutical supply chain, have manipulated a system full of perverse incentives and have stacked the deck against consumers, pharmacies, employers, and taxpayers. These monopolistic companies have become 3 of the most powerful corporations in the world from profiting off an opaque and complex system at the expense of everyone else in the supply chain. These abusive, anti-competitive practices have created an epidemic of pharmacy closures and rising prescription drug prices nationwide. PBM driven overworked and understaffed pharmacies result in burnt out staff, risks to public safety, and a lower level of care than Iowans deserve. Community pharmacists want to care for their communities and it’s time that they get an even playing field to do just that.

This bill provides transparency in a broken system, empowers patients to choose their healthcare provider, requires that the dollars in the system benefit patients and employers, and ensures that pharmacies can keep their doors open by reimbursing what it costs to dispense prescriptions to Iowans.

PBM reform is a long time coming. Despite mistruths, dark money astroturf campaigns, and fear mongering, we have a really good bill in front of us that will move the needle to protect vital healthcare infrastructure in our state.

I want to thank Senator Mike Klimesh for being a great partner across the rotunda.

I’d also like to thank my subcommittee of Reps Lundgren and Wilson for the great bipartisan work we have done on this bill. I am also thankful for so many members of this body who met with their local pharmacists and actively advocated on behalf of this bill. I would leave someone out if I start naming names, but I am very thankful for the strong teamwork on this bill. I also want to give a shout out to former Reps Brian Best and John Forbes for their many years of work on PBM reform in the Iowa House.

Thank you to my pharmacist colleagues in the gallery and across the state who care for Iowans every day. Your stories and your advocacy make a difference and the health outcomes of Iowans are better for all you do.

By sending this bill to the Governor, Iowa will take a large step to catch back up with states across the country who have taken a leading role in reforming a broken system by reining in abusive PBM practices.

What does SF 383 do?

Prohibits a PBM or insurer from discriminating against a pharmacy if the pharmacy is acting within its license and all laws; Prohibits the removal of pharmacy choice or imposing any monetary advantages or penalties that result in removing pharmacy choice (including unnecessary specialty drug designations and requiring use of mail order pharmacies); Prohibits additional cost-sharing on the insured based on where they choose to have their prescription filled; Requires all rebates to be returned to the employee plan sponsor; Requires any amount paid by the insured for the prescription drug to be applied to their deductible; Requires PBMs to reimburse retail pharmacies (not large national chains and those with only mail order) based on acquisition cost; Prohibits spread pricing; Requires pharmacies have an appeals process if not reimbursed at acquisition cost; Requires regular reporting from the PBMs to the Insurance Division; Requires a study of Pharmacy Services Administrative Organizations and wholesales by IID with a report due by January 1, 2026.

I’m grateful for the opportunity to work hard on your behalf in Des Moines! Please reach out to me about any questions, concerns, or suggestions at brett.barker@legis.iowa.gov.

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Brett Barker, a Republican from Nevada, represents District 51 in the Iowa House.