House
File
2384
-
Reprinted
HOUSE
FILE
2384
BY
COMMITTEE
ON
COMMERCE
(SUCCESSOR
TO
HSB
623)
(As
Amended
and
Passed
by
the
House
March
23,
2022
)
A
BILL
FOR
An
Act
relating
to
pharmacy
benefits
managers,
pharmacies,
and
1
prescription
drug
benefits,
and
including
applicability
2
provisions.
3
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
4
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Section
1.
Section
505.26,
subsection
1,
paragraph
b,
Code
1
2022,
is
amended
to
read
as
follows:
2
b.
“Pharmacy
benefits
manager”
means
the
same
as
defined
in
3
section
510B.1
510C.1
.
4
Sec.
2.
Section
507B.4,
subsection
3,
Code
2022,
is
amended
5
by
adding
the
following
new
paragraph:
6
NEW
PARAGRAPH
.
t.
Pharmacy
benefits
managers.
Any
7
violation
of
chapter
510B
by
a
pharmacy
benefits
manager.
8
Sec.
3.
Section
510B.1,
Code
2022,
is
amended
by
striking
9
the
section
and
inserting
in
lieu
thereof
the
following:
10
510B.1
Definitions.
11
As
used
in
this
chapter,
unless
the
context
otherwise
12
requires:
13
1.
“Clean
claim”
means
a
claim
that
has
no
defect
or
14
impropriety,
including
a
lack
of
any
required
substantiating
15
documentation,
or
other
circumstances
requiring
special
16
treatment,
that
prevents
timely
payment
from
being
made
on
the
17
claim.
18
2.
“Commissioner
”
means
the
commissioner
of
insurance.
19
3.
“Cost-sharing”
means
any
coverage
limit,
copayment,
20
coinsurance,
deductible,
or
other
out-of-pocket
cost
obligation
21
imposed
by
a
health
benefit
plan
on
a
covered
person.
22
4.
“Covered
person”
means
a
policyholder,
subscriber,
or
23
other
person
participating
in
a
health
benefit
plan
that
has
24
a
prescription
drug
benefit
managed
by
a
pharmacy
benefits
25
manager.
26
5.
“Health
benefit
plan”
means
the
same
as
defined
in
27
section
514J.102.
28
6.
“Health
care
professional”
means
the
same
as
defined
in
29
section
514J.102.
30
7.
“Health
carrier”
means
an
entity
subject
to
the
31
insurance
laws
and
regulations
of
this
state,
or
subject
32
to
the
jurisdiction
of
the
commissioner,
including
an
33
insurance
company
offering
sickness
and
accident
plans,
a
34
health
maintenance
organization,
a
nonprofit
health
service
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corporation,
a
plan
established
pursuant
to
chapter
509A
1
for
public
employees,
or
any
other
entity
providing
a
plan
2
of
health
insurance,
health
care
benefits,
or
health
care
3
services.
“Health
carrier”
does
not
include
the
department
4
of
human
services,
or
a
managed
care
organization
acting
5
pursuant
to
a
contract
with
the
department
of
human
services
to
6
administer
the
medical
assistance
program
under
chapter
249A
7
or
the
healthy
and
well
kids
in
Iowa
(hawk-i)
program
under
8
chapter
514I.
9
8.
“Maximum
allowable
cost”
means
the
maximum
amount
that
a
10
pharmacy
will
be
reimbursed
by
a
pharmacy
benefits
manager
or
a
11
health
carrier
for
a
generic
drug,
brand-name
drug,
biologic
12
product,
or
other
prescription
drug,
and
that
may
include
any
13
of
the
following:
14
a.
Average
acquisition
cost.
15
b.
National
average
acquisition
cost.
16
c.
Average
manufacturer
price.
17
d.
Average
wholesale
price.
18
e.
Brand
effective
rate.
19
f.
Generic
effective
rate.
20
g.
Discount
indexing.
21
h.
Federal
upper
limits.
22
i.
Wholesale
acquisition
cost.
23
j.
Any
other
term
used
by
a
pharmacy
benefits
manager
or
a
24
health
carrier
to
establish
reimbursement
rates
for
a
pharmacy.
25
9.
“Maximum
allowable
cost
list”
means
a
list
of
26
prescription
drugs
that
includes
the
maximum
allowable
cost
27
for
each
prescription
drug
and
that
is
used,
directly
or
28
indirectly,
by
a
pharmacy
benefits
manager.
29
10.
“Pharmacist”
means
the
same
as
defined
in
section
30
155A.3.
31
11.
“Pharmacy”
means
the
same
as
defined
in
section
155A.3.
32
12.
“Pharmacy
acquisition
cost”
means
the
cost
to
a
33
pharmacy
for
a
prescription
drug
as
invoiced
by
a
wholesale
34
distributor,
and
reduced
by
any
discounts,
rebates,
or
other
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price
concessions
applicable
to
the
prescription
drug
that
are
1
not
shown
on
the
invoice
and
are
known
at
the
time
that
the
2
pharmacy
files
an
appeal
with
a
pharmacy
benefits
manager.
3
13.
“Pharmacy
benefits
manager”
means
the
same
as
defined
4
in
section
510C.1.
5
14.
“Pharmacy
benefits
manager
affiliate”
means
a
pharmacy
or
6
a
pharmacist
that
directly
or
indirectly
through
one
or
more
7
intermediaries,
owns
or
controls,
is
owned
and
controlled
by,
8
or
is
under
common
ownership
or
control
of,
a
pharmacy
benefits
9
manager.
10
15.
“Pharmacy
network”
or
“network”
means
pharmacies
that
11
have
contracted
with
a
pharmacy
benefits
manager
to
dispense
12
or
sell
prescription
drugs
to
covered
persons
of
a
health
13
benefit
plan
for
which
the
pharmacy
benefits
manager
manages
14
the
prescription
drug
benefit.
15
16.
“Prescription
drug”
means
the
same
as
defined
in
section
16
155A.3.
17
17.
“Prescription
drug
benefit”
means
the
same
as
defined
18
in
section
510C.1.
19
18.
“Prescription
drug
order”
means
the
same
as
defined
in
20
section
155A.3.
21
19.
“Rebate”
means
the
same
as
defined
in
section
510C.1.
22
20.
“Wholesale
distributor”
means
the
same
as
defined
in
23
section
155A.3.
24
Sec.
4.
Section
510B.4,
Code
2022,
is
amended
to
read
as
25
follows:
26
510B.4
Performance
of
duties
——
good
faith
——
conflict
of
27
interest.
28
1.
A
pharmacy
benefits
manager
shall
perform
the
pharmacy
29
benefits
manager’s
duties
exercising
exercise
good
faith
and
30
fair
dealing
in
the
performance
of
its
the
pharmacy
benefits
31
manager’s
contractual
obligations
toward
the
covered
entity
a
32
health
carrier
.
33
2.
A
pharmacy
benefits
manager
shall
notify
the
covered
34
entity
a
health
carrier
in
writing
of
any
activity,
policy,
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practice
ownership
interest,
or
affiliation
of
the
pharmacy
1
benefits
manager
that
presents
any
conflict
of
interest.
2
3.
A
pharmacy
benefits
manager
shall
act
in
the
best
3
interest
of
each
health
carrier
for
whom
the
pharmacy
benefits
4
manager
manages
a
prescription
drug
benefit
provided
by
the
5
health
carrier,
and
shall
discharge
its
duties
in
accordance
6
with
applicable
state
and
federal
law.
7
4.
A
pharmacy
benefits
manager,
health
carrier,
or
health
8
benefit
plan
shall
not
discriminate
against
a
pharmacy
9
or
a
pharmacist
with
respect
to
participation,
referral,
10
reimbursement
of
a
covered
service,
or
indemnification
if
a
11
pharmacist
is
acting
within
the
scope
of
the
pharmacist’s
12
license.
13
Sec.
5.
Section
510B.5,
Code
2022,
is
amended
to
read
as
14
follows:
15
510B.5
Contacting
covered
individual
persons
——
requirements.
16
A
pharmacy
benefits
manager,
unless
authorized
pursuant
to
17
the
terms
of
its
contract
with
a
covered
entity
health
carrier
,
18
shall
not
contact
any
covered
individual
person
without
19
the
express
written
permission
of
the
covered
entity
health
20
carrier
.
21
Sec.
6.
Section
510B.6,
Code
2022,
is
amended
to
read
as
22
follows:
23
510B.6
Dispensing
of
substitute
Substitute
prescription
drug
24
for
prescribed
drug
drugs
.
25
1.
The
following
provisions
shall
apply
when
if
a
pharmacy
26
benefits
manager
requests
the
dispensing
of
a
substitute
27
prescription
drug
for
a
prescribed
drug
to
prescribed
for
a
28
covered
individual
person
:
29
a.
The
pharmacy
benefits
manager
may
request
the
30
substitution
of
a
lower
priced
generic
and
therapeutically
31
equivalent
prescription
drug
for
a
higher
priced
prescribed
32
prescription
drug.
33
b.
If
the
substitute
prescription
drug’s
net
cost
to
the
34
covered
individual
person
or
covered
entity
to
the
health
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carrier
exceeds
the
cost
of
the
prescribed
prescription
drug
1
originally
prescribed
for
the
covered
person
,
the
substitution
2
shall
be
made
only
for
medical
reasons
that
benefit
the
covered
3
individual
person
.
4
2.
A
pharmacy
benefits
manager
shall
obtain
the
approval
of
5
the
prescribing
practitioner
health
care
professional
prior
to
6
requesting
any
substitution
under
this
section
.
7
3.
A
pharmacy
benefits
manager
shall
not
substitute
an
8
equivalent
prescription
drug
contrary
to
a
prescription
drug
9
order
that
prohibits
a
substitution.
10
Sec.
7.
Section
510B.7,
Code
2022,
is
amended
by
striking
11
the
section
and
inserting
in
lieu
thereof
the
following:
12
510B.7
Pharmacy
networks.
13
1.
A
pharmacy
located
in
the
state
shall
not
be
prohibited
14
from
participating
in
a
pharmacy
network
provided
that
the
15
pharmacy
accepts
the
same
terms
and
conditions
as
the
pharmacy
16
benefits
manager
imposes
on
the
pharmacies
in
the
network.
17
2.
A
pharmacy
benefits
manager
shall
not
assess,
charge,
or
18
collect
any
form
of
remuneration
that
passes
from
a
pharmacy
19
or
a
pharmacist
in
a
pharmacy
network
to
the
pharmacy
benefits
20
manager
including
but
not
limited
to
claim
processing
fees,
21
performance-based
fees,
network
participation
fees,
or
22
accreditation
fees.
23
Sec.
8.
Section
510B.8,
Code
2022,
is
amended
by
striking
24
the
section
and
inserting
in
lieu
thereof
the
following:
25
510B.8
Prescription
drugs
——
point
of
sale.
26
1.
A
covered
person
shall
not
be
required
to
make
a
27
cost-sharing
payment
at
the
point
of
sale
for
a
prescription
28
drug
in
an
amount
that
exceeds
the
total
amount
that
the
29
pharmacy
at
which
the
covered
person
fills
the
covered
person’s
30
prescription
drug
order
is
reimbursed.
31
2.
A
pharmacy
benefits
manager
shall
not
prohibit
a
pharmacy
32
from
disclosing
the
availability
of
a
lower-cost
prescription
33
drug
option
to
a
covered
person,
or
from
selling
a
lower-cost
34
prescription
drug
option
to
a
covered
person.
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3.
Any
amount
paid
by
a
covered
person
for
a
prescription
1
drug
purchased
pursuant
to
this
section
shall
be
applied
to
any
2
deductible
imposed
by
the
covered
person’s
health
benefit
plan
3
in
accordance
with
the
health
benefit
plan
coverage
documents.
4
4.
A
covered
person
shall
not
be
prohibited
from
filling
5
a
prescription
drug
order
at
any
pharmacy
located
in
the
6
state
provided
that
the
pharmacy
accepts
the
same
terms
and
7
conditions
as
the
pharmacies
participating
in
the
covered
8
person’s
health
benefit
plan’s
network.
9
5.
Excluding
incentives
in
value-based
programs
established
10
by
a
health
carrier
or
a
pharmacy
benefits
manager
to
promote
11
the
use
of
higher
quality
pharmacies,
a
pharmacy
benefits
12
manager
shall
not
impose
different
cost-sharing
or
additional
13
fees
on
a
covered
person
based
on
the
pharmacy
at
which
the
14
covered
person
fills
the
covered
person’s
prescription
drug
15
order.
16
6.
A
pharmacy
benefits
manager
shall
not
require
a
covered
17
person,
as
a
condition
of
payment
or
reimbursement,
to
purchase
18
pharmacy
services,
including
prescription
drugs,
exclusively
19
through
a
mail-order
pharmacy.
20
7.
a.
For
purposes
of
calculating
a
covered
person’s
21
contribution
toward
the
covered
person’s
cost-sharing,
a
22
pharmacy
benefits
manager
shall
include
all
cost-sharing
paid
23
by
the
covered
person
and
all
cost-sharing
paid
by
any
other
24
person
on
behalf
of
the
covered
person.
25
b.
If
application
of
paragraph
“a”
will
result
in
health
26
savings
account
ineligibility
under
section
223
of
the
Internal
27
Revenue
Code,
paragraph
“a”
shall
only
apply
to
the
covered
28
person’s
deductible
for
a
health
savings
account
qualified-high
29
deductible
health
plan
after
the
covered
person
has
satisfied
30
the
minimum
deductible
under
section
223
of
the
Internal
31
Revenue
Code,
except
for
items
or
services
that
are
preventive
32
care,
in
which
case,
the
requirement
shall
apply
regardless
of
33
if
the
minimum
deductible
under
section
223
of
the
Internal
34
Revenue
Code
has
been
satisfied.
For
purposes
of
this
section,
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“preventive
care”
means
the
same
as
under
section
223(c)(2)(C)
1
of
the
Internal
Revenue
Code.
2
c.
Paragraph
“a”
shall
not
apply
to
cost-sharing
paid
by
3
a
covered
person,
or
to
cost-sharing
paid
by
any
other
person
4
on
behalf
of
the
covered
person,
for
a
specialty
drug
or
for
5
a
prescription
drug
for
which
a
medically
appropriate
A-rated
6
generic
equivalent
or
an
interchangeable
biological
product
is
7
available
to
the
covered
person.
8
d.
Paragraph
“a”
shall
not
apply
to
a
state-regulated
9
high-deductible
health
plan
to
the
extent
application
10
of
paragraph
“a”
will
result
in
the
state-regulated
11
high-deductible
health
plan
not
qualifying
as
a
high-deductible
12
health
plan
under
section
223
of
the
Internal
Revenue
Code.
13
e.
If
paragraph
“a”
conflicts
with
a
federal
law
or
a
14
federal
regulation
as
applied
to
a
specific
health
carrier
or
15
to
a
specific
circumstance,
paragraph
“a”
shall
apply
to
all
16
health
carriers
and
in
all
circumstances
in
which
the
federal
17
law
or
federal
regulation
does
not
conflict.
18
Sec.
9.
NEW
SECTION
.
510B.8A
Maximum
allowable
cost
lists.
19
1.
Prior
to
placement
of
a
particular
prescription
drug
on
a
20
maximum
allowable
cost
list,
a
pharmacy
benefits
manager
shall
21
ensure
that
all
of
the
following
requirements
are
met:
22
a.
The
particular
prescription
drug
must
be
listed
as
23
therapeutically
and
pharmaceutically
equivalent
in
the
most
24
recent
edition
of
the
publication
entitled
“Approved
Drug
25
Products
with
Therapeutic
Equivalence
Evaluations”,
published
26
by
the
United
States
food
and
drug
administration,
otherwise
27
known
as
the
orange
book.
28
b.
The
particular
prescription
drug
must
not
be
obsolete
or
29
temporarily
unavailable.
30
c.
The
particular
prescription
drug
must
be
available
for
31
purchase,
without
limitations,
by
all
pharmacies
in
the
state
32
from
a
national
or
regional
wholesale
distributor
that
is
33
licensed
in
the
state.
34
2.
For
each
maximum
allowable
cost
list
that
a
pharmacy
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benefits
manager
uses
in
the
state,
the
pharmacy
benefits
1
manager
shall
do
all
of
the
following:
2
a.
Provide
each
pharmacy
in
a
pharmacy
network
reasonable
3
access
to
the
maximum
allowable
cost
list
to
which
the
pharmacy
4
is
subject.
5
b.
Update
the
maximum
allowable
cost
list
within
seven
6
calendar
days
from
the
date
of
an
increase
of
ten
percent
or
7
more
in
the
pharmacy
acquisition
cost
of
a
prescription
drug
on
8
the
list
by
one
or
more
wholesale
distributors
doing
business
9
in
the
state.
10
c.
Update
the
maximum
allowable
cost
list
within
seven
11
calendar
days
from
the
date
of
a
change
in
the
methodology,
or
12
a
change
in
the
value
of
a
variable
applied
in
the
methodology,
13
on
which
the
maximum
allowable
cost
list
is
based.
14
d.
Provide
a
reasonable
process
for
each
pharmacy
in
a
15
pharmacy
network
to
receive
prompt
notice
of
all
changes
to
the
16
maximum
allowable
cost
list
to
which
the
pharmacy
is
subject.
17
Sec.
10.
NEW
SECTION
.
510B.8C
Pharmacy
benefits
manager
18
affiliates
——
reimbursement.
19
A
pharmacy
benefits
manager
shall
not
reimburse
any
pharmacy
20
located
in
the
state
in
an
amount
less
than
the
amount
that
21
the
pharmacy
benefits
manager
reimburses
a
pharmacy
benefits
22
manager
affiliate
for
dispensing
the
same
prescription
drug
23
as
dispensed
by
the
pharmacy.
The
reimbursement
amount
shall
24
be
calculated
on
a
per
unit
basis
based
on
the
same
generic
25
product
identifier
or
generic
code
number.
26
Sec.
11.
NEW
SECTION
.
510B.8D
Clean
claims.
27
After
the
date
of
receipt
of
a
clean
claim
submitted
by
a
28
pharmacy
in
a
pharmacy
network,
a
pharmacy
benefits
manager
29
shall
not
retroactively
reduce
payment
on
the
claim,
either
30
directly
or
indirectly
except
in
the
following
circumstances:
31
a.
The
claim
is
found
not
to
be
a
clean
claim
during
the
32
course
of
a
routine
audit.
33
b.
The
claim
submission
was
fraudulent.
34
c.
The
claim
submission
was
a
duplicate
submission
of
a
35
-8-
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2384
(2)
89
ko/rn/md
8/
12
H.F.
2384
claim
for
which
the
pharmacy
had
already
received
payment.
1
Sec.
12.
NEW
SECTION
.
510B.8E
Appeals
and
disputes.
2
1.
A
pharmacy
benefits
manager
shall
provide
a
reasonable
3
process
to
allow
a
pharmacy
to
appeal
a
maximum
allowable
cost
4
or
reimbursement
rate
for
a
specific
prescription
drug
for
any
5
of
the
following
reasons:
6
a.
The
pharmacy
benefits
manager
violated
section
510B.8A.
7
b.
The
maximum
allowable
cost
or
the
reimbursement
rate
is
8
below
the
pharmacy
acquisition
cost.
9
2.
The
appeal
process
must
include
all
of
the
following:
10
a.
A
dedicated
telephone
number
at
which
a
pharmacy
may
11
contact
the
pharmacy
benefits
manager
and
speak
directly
with
12
an
individual
involved
in
the
appeal
process.
13
b.
A
dedicated
electronic
mail
address
or
internet
site
for
14
the
purpose
of
submitting
an
appeal
directly
to
the
pharmacy
15
benefits
manager.
16
c.
A
period
of
at
least
thirty
business
days
after
the
date
17
of
a
pharmacy’s
initial
submission
of
a
clean
claim
during
18
which
the
pharmacy
may
initiate
an
appeal.
19
3.
A
pharmacy
benefits
manager
shall
respond
to
an
appeal
20
within
seven
business
days
after
the
date
on
which
the
pharmacy
21
benefits
manager
receives
the
appeal.
22
a.
If
the
pharmacy
benefits
manager
grants
a
pharmacy’s
23
appeal,
the
pharmacy
benefits
manager
shall
do
all
of
the
24
following:
25
(1)
Adjust
the
maximum
allowable
cost
or
the
reimbursement
26
rate
of
the
prescription
drug
that
is
the
subject
of
the
appeal
27
and
provide
the
national
drug
code
number
that
the
adjustment
28
is
based
on
to
the
appealing
pharmacy.
29
(2)
Permit
the
appealing
pharmacy
to
reverse
and
resubmit
30
the
claim
that
is
the
subject
of
the
appeal.
31
(3)
Make
the
adjustment
pursuant
to
subparagraph
(1)
32
applicable
to
all
of
the
following:
33
(a)
Each
pharmacy
that
is
under
common
ownership
with
the
34
pharmacy
that
submitted
the
appeal.
35
-9-
HF
2384
(2)
89
ko/rn/md
9/
12
H.F.
2384
(b)
Each
pharmacy
in
the
state
that
demonstrates
the
1
inability
to
purchase
the
prescription
drug
for
less
than
the
2
established
maximum
allowable
cost
or
reimbursement
rate.
3
b.
If
the
pharmacy
benefits
manager
denies
a
pharmacy’s
4
appeal,
the
pharmacy
benefits
manager
shall
do
all
of
the
5
following:
6
(1)
Provide
the
appealing
pharmacy
the
national
drug
7
code
number
and
the
name
of
a
wholesale
distributor
licensed
8
pursuant
to
section
155A.17
from
which
the
pharmacy
can
obtain
9
the
prescription
drug
at
or
below
the
maximum
allowable
cost
10
or
reimbursement
rate.
11
(2)
If
the
prescription
drug
identified
by
the
national
drug
12
code
number
provided
by
the
pharmacy
benefits
manager
pursuant
13
to
subparagraph
(1)
is
not
available
below
the
pharmacy
14
acquisition
cost
from
the
wholesale
distributor
from
whom
the
15
pharmacy
purchases
the
majority
of
its
prescription
drugs
for
16
resale,
the
pharmacy
benefits
manager
shall
adjust
the
maximum
17
allowable
cost
or
the
reimbursement
rate
above
the
appealing
18
pharmacy’s
pharmacy
acquisition
cost,
and
permit
the
pharmacy
19
to
reverse
and
resubmit
each
claim
affected
by
the
pharmacy’s
20
inability
to
procure
the
prescription
drug
at
a
cost
that
is
21
equal
to
or
less
than
the
previously
appealed
maximum
allowable
22
cost
or
the
reimbursement
rate.
23
Sec.
13.
Section
510B.9,
Code
2022,
is
amended
to
read
as
24
follows:
25
510B.9
Submission,
approval,
and
use
of
prior
Prior
26
authorization
form
.
27
A
pharmacy
benefits
manager
shall
file
with
and
have
28
approved
by
the
commissioner
a
single
prior
authorization
29
form
as
provided
in
section
505.26
comply
with
all
applicable
30
prior
authorization
requirements
pursuant
to
section
505.26
.
31
A
pharmacy
benefits
manager
shall
use
the
single
prior
32
authorization
form
as
provided
in
section
505.26
.
33
Sec.
14.
Section
510B.10,
Code
2022,
is
amended
by
striking
34
the
section
and
inserting
in
lieu
thereof
the
following:
35
-10-
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2384
(2)
89
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12
H.F.
2384
510B.10
Enforcement.
1
1.
The
commissioner
may
take
any
enforcement
action
under
2
the
commissioner’s
authority
to
enforce
compliance
with
this
3
chapter.
4
2.
After
notice
and
hearing,
the
commissioner
may
issue
any
5
order
or
impose
any
penalty
pursuant
to
section
507B.7,
and
may
6
suspend
or
revoke
a
pharmacy
benefits
manager’s
certificate
7
of
registration
as
a
third-party
administrator
upon
a
finding
8
that
the
pharmacy
benefits
manager
violated
this
chapter,
9
or
any
applicable
requirements
pertaining
to
third-party
10
administrators
under
chapter
510.
11
3.
A
pharmacy
benefits
manager
shall
be
subject
to
the
12
commissioner’s
authority
to
conduct
an
examination
pursuant
to
13
chapter
507.
14
4.
A
pharmacy
benefits
manager
is
subject
to
the
15
commissioner’s
authority
to
conduct
a
proceeding
pursuant
16
to
chapter
507B.
The
procedures
set
forth
in
chapter
507B
17
regarding
proceedings
shall
apply
to
a
proceeding
related
to
a
18
pharmacy
benefits
manager
under
this
chapter.
19
5.
A
pharmacy
benefits
manager
is
subject
to
the
20
commissioner’s
authority
to
conduct
an
examination,
audit,
21
or
inspection
pursuant
to
chapter
510
for
third-party
22
administrators.
The
procedures
set
forth
in
chapter
510
for
23
third-party
administrators
shall
apply
to
an
examination,
24
audit,
or
inspection
of
a
pharmacy
benefits
manager
under
this
25
chapter.
26
6.
If
the
commissioner
conducts
an
examination
of
a
pharmacy
27
benefits
manager
under
chapter
507;
a
proceeding
under
chapter
28
507B;
or
an
examination,
audit,
or
inspection
under
chapter
29
510,
all
information
received
from
the
pharmacy
benefits
30
manager,
and
all
notes,
work
papers,
or
other
documents
related
31
to
the
examination,
proceeding,
audit,
or
inspection
shall
32
be
confidential
records
pursuant
to
chapter
22
and
shall
be
33
accorded
the
same
confidentiality
as
notes,
work
papers,
34
investigatory
materials,
or
other
documents
related
to
the
35
-11-
HF
2384
(2)
89
ko/rn/md
11/
12
H.F.
2384
examination
of
an
insurer
as
provided
in
section
507.14.
1
7.
A
violation
of
this
chapter
shall
be
an
unfair
or
2
deceptive
act
or
practice
in
the
business
of
insurance
pursuant
3
to
section
507B.4,
subsection
3.
4
Sec.
15.
NEW
SECTION
.
510B.11
Rules.
5
The
commissioner
may
adopt
rules
pursuant
to
chapter
17A
to
6
administer
this
chapter.
7
Sec.
16.
NEW
SECTION
.
510B.12
Severability.
8
If
a
provision
of
this
chapter
or
its
application
to
any
9
person
or
circumstance
is
held
invalid,
the
invalidity
does
10
not
affect
other
provisions
or
applications
of
this
chapter
11
which
can
be
given
effect
without
the
invalid
provision
or
12
application,
and
to
this
end
the
provisions
of
this
chapter
are
13
severable.
14
Sec.
17.
REPEAL.
Section
510B.3,
Code
2022,
is
repealed.
15
Sec.
18.
APPLICABILITY.
1.
This
Act
applies
to
pharmacy
16
benefits
managers
that
manage
a
health
carrier’s
prescription
17
drug
benefit
in
the
state
on
or
after
the
effective
date
of
18
this
Act.
19
2.
The
following
applies
to
all
health
benefit
plans
20
delivered,
issued
for
delivery,
continued,
or
renewed
in
this
21
state
on
or
after
January
1,
2023:
22
The
section
of
this
Act
amending
section
510B.8,
subsection
23
7.
24
-12-
HF
2384
(2)
89
ko/rn/md
12/
12