ARC 4068C
HUMAN SERVICES DEPARTMENT[441]
Adopted and Filed
Rule making related to pharmacy copayment
The Human Services Department hereby amends Chapter 79, “Other Policies Relating to Providers of Medical and Remedial Care,” Iowa Administrative Code.
Legal Authority for Rule Making
This rule making is adopted under the authority provided in Iowa Code section 249A.4.
State or Federal Law Implemented
This rule making implements, in whole or in part, Iowa Code section 249A.4.
Purpose and Summary
This amendment makes the pharmacy copayment a flat copayment of $1 per prescription or refill. Consistent with federal regulations and state legislative requirement, the copayment will no longer be based on the preferred or nonpreferred status of the drug on the preferred drug list (PDL).
This amendment is technical in nature because this copayment policy of $1 per prescription or refill has been in place to implement the federal final rule (CMS-2334-F) requirement. The copayment requirement provides that a nonpreferred drug copay must be limited to the amount of a preferred drug copay when the nonpreferred drug is deemed medically necessary by the prescribing provider. Since implementation of this final rule, all Medicaid drug copayments are the preferred amount of $1 because a Medicaid member would not get a nonpreferred drug unless the drug was medically necessary.
Public Comment and Changes to Rule Making
Notice of Intended Action for this rule making was published in the Iowa Administrative Bulletin on August 1, 2018, as ARC 3906C. The Department received no comments on this rule making during the public comment period. No changes from the Notice have been made.
Adoption of Rule Making
This rule making was adopted by the Council on Human Services on September 12, 2018.
Fiscal Impact
This rule making has no fiscal impact to the State of Iowa.
Jobs Impact
After analysis and review of this rule making, no impact on jobs has been found.
Waivers
Any person who believes that the application of the discretionary provisions of this rule making would result in hardship or injustice to that person may petition the Department for a waiver of the discretionary provisions, if any, pursuant to rule 441—1.8(17A,217).
Review by Administrative Rules Review Committee
The Administrative Rules Review Committee, a bipartisan legislative committee which oversees rule making by executive branch agencies, may, on its own motion or on written request by any individual or group, review this rule making at its regular monthly meeting or at a special meeting. The Committee’s meetings are open to the public, and interested persons may be heard as provided in Iowa Code section 17A.8(6).
Effective Date
This rule making will become effective on December 1, 2018.
The following rule-making action is adopted:
	Amend paragraph 79.1(13)“a” as follows:
	a. 	The member shall pay a copayment of $1 for each covered prescription or refill of any covered drug. as follows:
	(1)	One dollar for generic drugs and preferred brand-name drugs. Any brand-name drug that is not subject to prior approval based on nonpreferred status on the preferred drug list published by the department pursuant to Iowa Code section 249A.20A shall be treated as a preferred brand-name drug.
	(2)	Rescinded IAB 7/6/05, effective 7/1/05.
	(3)	One dollar for nonpreferred brand-name drugs for which the cost to the state is less than $25.
	(4)	Two dollars for nonpreferred brand-name drugs for which the cost to the state is $25.01 to $50.
	(5)	Three dollars for nonpreferred brand-name drugs for which the cost to the state is $50.01 or more.
	(6)	For the purpose of this paragraph, the cost to the state is determined without regard to federal financial participation in the Medicaid program or to any rebates received.
[Filed 9/12/18, effective 12/1/18]
[Published 10/10/18]
Editor’s Note: For replacement pages for IAC, see IAC Supplement 10/10/18.