House Journal: Page 956: Wednesday, April 2, 2003
35 5. A pharmacy benefits manager that contracts with
36 a pharmacy or pharmacist to provide pharmacist
37 services through a pharmacy benefits management plan
38 for enrollees in this state on behalf of any health
39 plan sponsors shall be identified as the agent of the
40 health plan sponsor. The health plan fiduciary
41 responsibilities shall transfer to the contracting
42 pharmacy benefits manager.
43 6. A contract shall apply the same coinsurance,
44 copayment, and deductible to covered drug
45 prescriptions filled by any pharmacy or pharmacist who
46 participates in the network.
47 7. This section shall not be construed to prohibit
48 a contract from applying different coinsurance,
49 copayment, and deductible factors between generic and
50 brand-name drugs that an enrollee may obtain with a
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1 prescription if the limits are applied uniformly to
2 all pharmacies or pharmacists in the health insurance
3 plan or contract network.
4 8. A pharmacy benefits management plan shall not
5 require a pharmacy or pharmacist to change an
6 enrollee's maintenance drug unless the prescribing
7 physician and the enrollee agree to the change.
8 9. A pharmacy's or pharmacist's participation in
9 any plan or network offered by a pharmacy benefits
10 manager is optional and at the discretion of the
11 pharmacy or pharmacist. The pharmacy's or
12 pharmacist's participation or lack of participation in
13 one plan shall not affect the pharmacy's or
14 pharmacist's participation in any other plan or
15 network ordered by the pharmacy benefits manager.
16 10. A pharmacy benefits manager that initiates an
17 audit of a pharmacy or pharmacist under the provisions
18 of the contract shall limit the methods and procedures
19 that are recognized as fair and equitable for both the
20 pharmacy benefits manager and the pharmacy or
21 pharmacist. An audit shall not allow for
22 extrapolation calculations. A pharmacy benefits
23 manager shall not recoup any moneys due from an audit
24 by setoff from future remittances until the results of
25 the audit are resolved and finalized by both the
26 pharmacy benefits manager and the pharmacy or
27 pharmacist. If the findings of an audit cannot be
28 finalized and agreed to by both parties, the
29 commissioner shall establish an independent review
30 board to adjudicate unresolved grievances.
31 11. a. Prior to terminating a pharmacy or
32 pharmacist from the network, a pharmacy benefits
33 manager shall provide the pharmacy or pharmacist with
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League of Women Voters of Iowa
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