1. A pharmacy benefits manager shall exercise good faith and fair dealing in the performance of the pharmacy benefits manager‘s contractual obligations toward a third-party payor.

Terms Used In Iowa Code 510B.4

  • Health carrier: means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the commissioner, including an insurance company offering sickness and accident plans, a health maintenance organization, a nonprofit health service corporation, or a plan established pursuant to chapter 509A for public employees. See Iowa Code 510B.1
  • Pharmacy: means the same as defined in section 155A. See Iowa Code 510B.1
  • Pharmacy benefits manager: means a person who, pursuant to a contract or other relationship with a third-party payor, either directly or through an intermediary, manages a prescription drug benefit provided by the third-party payor. See Iowa Code 510B.1
  • Prescription drug: means the same as defined in section 155A. See Iowa Code 510B.1
  • state: when applied to the different parts of the United States, includes the District of Columbia and the territories, and the words "United States" may include the said district and territories. See Iowa Code 4.1
  • Third-party payor: includes health carriers and other entities that provide a plan of health insurance or health care benefits. See Iowa Code 510B.1
 2. A pharmacy benefits manager shall notify a health carrier in writing of any activity, policy, practice ownership interest, or affiliation of the pharmacy benefits manager that presents any conflict of interest.
 3. A pharmacy benefits manager shall act in the best interest of each third-party payor for whom the pharmacy benefits manager manages a prescription drug benefit provided by the third-party payor, and shall discharge its duties in accordance with applicable state and federal law.
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