Stand for Iowa patients, not PBM profiteering

The loudest voices in health policy come from those who have the most to lose when transparency is introduced. We are seeing this play out today with the backlash to Senate File 383, Iowa’s bipartisan pharmacy benefit manager (PBM) reform law.

As a practicing pharmacist in Iowa, I see firsthand how patients struggle with surprise fees, confusing coverage restrictions, and sudden changes that force them to abandon their trusted local pharmacies. These are not glitches. They are by design. PBMs, the corporate middlemen hired to administer prescription drug benefits, profit from complexity, opacity, and control. SF 383 will disrupt that.

The law ensures PBMs are licensed in Iowa, prevented from steering patients to PBM- owned pharmacies, and prohibited from engaging in spread pricing, a practice in which PBMs charge employers one price and reimburse pharmacies far less, pocketing the difference.

These are not radical concepts. They are basic guardrails to protect Iowa businesses, pharmacists, and most importantly, patients.

The claim that SF 383 will raise health care costs by hundreds of millions of dollars is a scare tactic, not a fact. PBMs have never provided audited, Iowa-specific data to justify such a claim. What we do know is that PBMs have consistently failed to pass savings on to employers and patients while squeezing pharmacies to the point of closure, especially in rural areas. Since 2014, harmful PBM practices have forced more than 200 Iowa pharmacies to close.

The Iowa Association of Business and Industry’s assertion in its lawsuit challenging SF 383 that the law restricts commercial free speech is also misleading. Employers are still free to communicate benefits information. The law stops PBMs from penalizing patients for choosing a pharmacy outside their corporate network or coercing them to use mail order pharmacies even when a local provider is available. That is not speech. It is manipulation.

Pharmacies are small businesses, employers, and critical health access points in every Iowa community. When PBM practices force them to close, the consequences ripple far beyond prescription access. SF 383 is about keeping care local and restoring balance to a system in which the rules have long been written by powerful intermediaries with no accountability.

We hope Iowa’s business leaders look deeper than the talking points and recognize what is at stake: the health and sustainability of our communities. Taking a stand should mean standing with Iowans, not with the corporations quietly extracting value from them.

Dr. Wes Pilkington has owned Evans Crossing Pharmacy in Evansdale since 2018. He is the president of the Iowa Pharmacy Association Board of Trustees.