510B.6  Substitute prescription drugs.
  1.  The following provisions shall apply if a pharmacy benefits manager requests the dispensing of a substitute prescription drug for a drug prescribed for a covered person:
  a.  The pharmacy benefits manager may request the substitution of a lower priced generic and therapeutically equivalent prescription drug for a higher priced prescription drug.
  b.  If the substitute prescription drug’s net cost to the covered person or to the health carrier exceeds the cost of the prescription drug originally prescribed for the covered person, the substitution shall be made only for medical reasons that benefit the covered person.
  2.  A pharmacy benefits manager shall obtain the approval of the prescribing health care professional prior to requesting any substitution under this section.
  3.  A pharmacy benefits manager shall not substitute an equivalent prescription drug contrary to a prescription drug order that prohibits a substitution.
2007 Acts, ch 193, §6, 9; 2022 Acts, ch 1113, §5, 16, 23
2022 amendment applies to pharmacy benefits managers that manage a prescription drug benefit in the state on or after June 13, 2022; 2022 Acts, ch 1113, §16
Section amended