510B.1 Definitions. As used in this chapter, unless the context otherwise requires: 1. “Commissioner” means the commissioner of insurance. 2. “Covered entity” means a nonprofit hospital or medical services corporation, health insurer, health benefit plan, or health maintenance organization; a health program administered by a department or the state in the capacity of provider of […]
510B.10 Rights related to covered individuals. 1. A pharmacy or pharmacist, as defined in section 155A.3, has the right to provide a covered individual information regarding the amount of the covered individual’s cost share for a prescription drug. A pharmacy benefits manager shall not prohibit a pharmacy or pharmacist from discussing any such information or […]
510B.2 Certification as a third-party administrator required. A pharmacy benefits manager doing business in this state shall obtain a certificate as a third-party administrator under chapter 510, and the provisions relating to a third-party administrator pursuant to chapter 510 shall apply to a pharmacy benefits manager. 2007 Acts, ch 193, §2, 9
510B.3 Enforcement — rules. 1. The commissioner shall enforce the provisions of this chapter. After notice and hearing, the commissioner may impose any or all of the sanctions set out in section 507B.7 and may suspend or revoke a pharmacy benefits manager’s certificate of registration as a third-party administrator pursuant to chapter 510, upon finding […]
510B.4 Performance of duties — good faith — conflict of interest. 1. A pharmacy benefits manager shall perform the pharmacy benefits manager’s duties exercising good faith and fair dealing in the performance of its contractual obligations toward the covered entity. 2. A pharmacy benefits manager shall notify the covered entity in writing of any activity, […]
510B.5 Contacting covered individual — requirements. A pharmacy benefits manager, unless authorized pursuant to the terms of its contract with a covered entity, shall not contact any covered individual without the express written permission of the covered entity. 2007 Acts, ch 193, §5, 9
510B.6 Dispensing of substitute prescription drug for prescribed drug. 1. The following provisions shall apply when a pharmacy benefits manager requests the dispensing of a substitute prescription drug for a prescribed drug to a covered individual: a. The pharmacy benefits manager may request the substitution of a lower priced generic and therapeutically equivalent drug for […]
510B.7 Duties to pharmacy network providers. 1. A pharmacy benefits manager shall not mandate basic recordkeeping that is more stringent than that required by state or federal law or regulation. 2. If a pharmacy benefits manager receives notice from a covered entity of termination of the covered entity’s contract, the pharmacy benefits manager shall notify, […]
510B.8 Pricing methodology for maximum reimbursement amount. 1. The commissioner may require a pharmacy benefits manager to submit information to the commissioner related to the pharmacy benefits manager’s pricing methodology for maximum reimbursement amount. 2. For purposes of the disclosure of pricing methodology, maximum reimbursement amounts shall be implemented as follows: a. Established for multiple-source […]
510B.9 Submission, approval, and use of prior authorization form. A pharmacy benefits manager shall file with and have approved by the commissioner a single prior authorization form as provided in section 505.26. A pharmacy benefits manager shall use the single prior authorization form as provided in section 505.26. 2014 Acts, ch 1140, §100, 101
