DES MOINES, Iowa — As the end of the 2025 legislative session is near, the PBM reform bill is still waiting for its fate.

Pharmacists across the state have championed a bill that would reform the practices of pharmacy benefit managers (PBMs), or the middlemen between pharmacies and insurance companies. PBMs determine the total drug costs for insurers, shape patients’ access to medications, and determine how much pharmacies are paid.

In 2024, 31 pharmacies in 22 counties closed in the state of Iowa, according to the Iowa Pharmacy Association (IPA), and an estimated 955,000 Iowans have been affected by these closures.

These closures are largely the result of PBM practices, including not being reimbursed at fair rates. PBMs often pay pharmacies less money than it costs for the pharmacy to purchase drugs and distribute prescriptions. This was the case for pharmacies in Oskaloosa, Minden, Colfax, and Eagle Grove.

The legislation proposed this session would require PBMs to reimburse pharmacies for their cost and enable patients to choose the pharmacy they want to receive care from.

The bill is on the Monday debate schedule for the Iowa House of Representatives.

An amendment to the bill was proposed by State Representative Bill Gustoff of District 40 on Monday morning.

State Representative and pharmacist Brett Barker of District 51 opposes the amendment and said it’s detrimental to pharmacies in Iowa.

“It guts the bill. It strikes the core provisions. It actually is a reimbursement increase on your smallest pharmacies, so it’s something that absolutely does not help small pharmacies. It would be a step backwards from current law and I’m absolutely advocating against it,” he said.

Over 100 pharmacists were at the State House Monday morning, speaking with lawmakers as they entered. Many were optimistic until they heard news about the amendment.

Heidi Van Buren was one of them. She said PBM reform is necessary to keep her pharmacy open.

“I feel like I’m carrying a rock going into a sword fight,” she said. “If I sign the current contract that [a PBM] has sent to us, my pharmacy will be closed within months.”

Representative Gustoff did not immediately respond to a request for comment on the amendment.

Both the original bill and the amended bill will be debated on Monday. Whichever is passed will head to Governor Kim Reynolds’ desk.