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 from selling a more affordable alternative to the covered individual, if one is available.
2. A health benefit plan, as defined in section 514J.102, issued or renewed on or after July 1, 2018, that provides coverage for pharmacy benefits shall not require a covered individual to pay a copayment for pharmacy benefits that exceeds the pharmacy’s or pharmacist’s submitted charges.
3. Any amount paid by a covered individual for a covered prescription drug pursuant to this section shall be applied toward any deductible imposed by the covered individual’s health benefit plan in accordance with the covered individual’s health benefit plan coverage documents.
4. To the extent that any provision of this section is inconsistent or conflicts with applicable federal law, rule, or regulation, such federal law, rule, or regulation shall prevail to the extent necessary to eliminate the inconsistency or conflict.
2018 Acts, ch 1165, §140
Structure Iowa Code
Chapter 510B - REGULATION OF PHARMACY BENEFITS MANAGERS
Section 510B.2 - Certification as a third-party administrator required.
Section 510B.3 - Enforcement — rules.
Section 510B.4 - Performance of duties — good faith — conflict of interest.
Section 510B.5 - Contacting covered individual — requirements.
Section 510B.6 - Dispensing of substitute prescription drug for prescribed drug.
Section 510B.7 - Duties to pharmacy network providers.
Section 510B.8 - Pricing methodology for maximum reimbursement amount.
Section 510B.9 - Submission, approval, and use of prior authorization form.