Calling it a “difficult decision,” Gov. Kim Reynolds signed legislation Wednesday that’s intended to help keep rural pharmacies in business but could also lead to higher drug costs for Iowans.At the urging of the state’s pharmacists, the Iowa Legislature approved the measure earlier this year. Senate File 383 imposes restrictions and regulations on pharmacy benefit managers, or PBMs, that negotiate prescription drug prices between manufacturers, health insurance companies and pharmacies.The law limits PBMs’ use of strategies that favor a specific pharmacy to fill a prescription — such as cost-sharing rates, fees, and other financial penalties or incentives. The legislation would also require pharmacies to be reimbursed at the average state or national price for a drug. Supporters have claimed the law is needed to combat “anti-competitive” practices by PBMs that they say give an advantage to mail-order prescription refills and larger pharmacy chains that have greater purchasing power.In signing the bill, Reynolds said that while PBMs have helped negotiate drug prices and access for millions of Americans, consolidation has led to only three major PBMs controlling 80% of the market, giving them “outsized power” in determining what patients pay for their medications.“But this bill does not signify an end,” she said. “The complexity and lack of verifiable data made signing this bill a difficult decision and my administration will closely monitor implementation to mitigate and ensure that any unintended consequences for private employers are addressed.” A Legislative Services Agency analysis found the bill could result in higher costs and co-pays for the state’s health insurance program. The Iowa Association of Business and Industry warned it could result in an additional $340 million in costs for private-sector health insurance plans and add $169 annually to the average insured Iowan’s pharmaceutical expenses.Earlier this year, Rep. Jeff Cooling, D-Cedar Rapids, warned that while the bill may initially increase revenue for smaller pharmacies, the added cost for consumers and their employers will give Iowans even more incentive to fill their prescriptions at a lower cost through larger pharmacies. The Iowa Pharmacy Association said the new law “marks a major victory for Iowa patients, independent and community pharmacies, and healthcare providers across the state” by ensuring greater oversight of PBMs.“For too long, PBMs have put profits over patients, contributing to the closure of more than 200 pharmacies in Iowa since 2014,” said Kate Gainer, CEO of the Iowa Pharmacy Association. “This law gives us the tools to level the playing field and protect access to care, especially in rural areas.” Iowa Capital Dispatch is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Iowa Capital Dispatch maintains editorial independence. Contact Editor Kathie Obradovich for questions: info@iowacapitaldispatch.com.