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 that the pharmacy benefits manager violated any of the requirements of this chapter or of chapter 510 pertaining to third-party administrators.
2. A pharmacy benefits manager, as an agent or vendor of an insurance company, is subject to the commissioner’s authority to conduct an examination pursuant to chapter 507. The procedures set forth in chapter 507 regarding examination reports shall apply to an examination of a pharmacy benefits manager under this chapter.
3. A pharmacy benefits manager is subject to the commissioner’s authority to conduct an investigation pursuant to chapter 507B. The procedures set forth in chapter 507B regarding investigations shall apply to an investigation of a pharmacy benefits manager under this chapter.
4. A pharmacy benefits manager is subject to the commissioner’s authority to conduct an examination, audit, or inspection pursuant to chapter 510 for third-party administrators. The procedures set forth in chapter 510 for third-party administrators shall apply to an examination, audit, or inspection of a pharmacy benefits manager under this chapter.
5. When the commissioner conducts an examination of a pharmacy benefits manager under chapter 507; an investigation under chapter 507B; or an examination, audit, or inspection under chapter 510, all information received from the pharmacy benefits manager, and all notes, work papers, or other documents related to the examination, investigation, audit, or inspection of the pharmacy benefits manager are confidential records under chapter 22 and shall be accorded the same confidentiality as notes, work papers, investigatory materials, or other documents related to the examination of an insurer as provided in chapter 507.
6. The commissioner shall adopt rules pursuant to chapter 17A to administer this chapter including rules relating to all of the following:
a. Timely payment of pharmacy claims.
b. A process for adjudication of complaints and settlement of disputes between a pharmacy benefits manager and a licensed pharmacy related to pharmacy auditing practices, termination of pharmacy agreements, and timely payment of pharmacy claims.
c. A process for the submission of forms.
2007 Acts, ch 193, §3, 9; 2014 Acts, ch 1140, §99, 101; 2015 Acts, ch 24, §1 – 3
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.