House Journal: Page 958: Wednesday, April 2, 2003
33 Pharmacy benefits managers shall use a current and
34 nationally recognized benchmark on which to base
35 reimbursements for prescription drugs and products
36 dispensed by pharmacies and pharmacists as follows:
37 1. For brand-name, single-source products, the
38 average wholesale price as listed in first data bank
39 or facts and comparisons correct and current on the
40 date the service was provided shall be used as the
41 index.
42 2. For generic drug, multisource products, maximum
43 allowable cost shall be established by referencing
44 first data bank facts and comparisons baseline prices.
45 Only products that are compliant with pharmacy laws as
46 equivalent and generically interchangeable with a
47 federal food and drug administration orange book
48 rating of "A-B" shall be reimbursed from a maximum
49 allowable cost price methodology. In the event a
50 multisource product has no baseline price, the product
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1 shall be treated as a single-source branded drug for
2 the purpose of valuing reimbursement.
3 Sec. . NEW SECTION. 155B.12 PROHIBITED
4 PRACTICES.
5 1. A pharmacy benefits manager or its
6 representative shall not cause or knowingly permit any
7 of the following:
8 a. The use of advertising that is untrue or
9 misleading.
10 b. Solicitation that is untrue or misleading.
11 c. Any form of evidence of coverage that is
12 deceptive.
13 2. A pharmacy benefits manager, unless licensed as
14 an insurer, shall not use in its name, contracts, or
15 literature any of the following:
16 a. Any form of the word "insurance", "casualty",
17 "surety", or "mutual".
18 b. Any other words descriptive of the insurance,
19 casualty, or surety business, or deceptively similar
20 to the name or description of any insurer or fidelity
21 and surety insurer, doing business in this state.
22 3. A pharmacy benefits manager shall not
23 discriminate on the basis of race, creed, color, sex,
24 or religion in the selection of pharmacies or
25 pharmacists with whom the company does business.
26 4. A pharmacy benefits manager shall not unfairly
27 discriminate against pharmacists when contracting for
28 pharmacists' services.
29 5. A pharmacy benefits manager shall be entitled
30 access to usual and customary pricing only for
31 comparison to the reimbursement of a specific claims
© 2003 Cornell College and
League of Women Voters of Iowa
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