Iowa Code 510B.8 – Prescription drugs — point of sale
Current as of: 2023 | Check for updates
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1. A covered person shall not be required to make a cost-sharing payment at the point of sale for a prescription drug in an amount that exceeds the total amount that the pharmacy at which the covered person fills the covered person’s prescription drug order is reimbursed.
Terms Used In Iowa Code 510B.8
- Cost-sharing: means any coverage limit, copayment, coinsurance, deductible, or other out-of-pocket cost obligation imposed by a health benefit plan on a covered person. See Iowa Code 510B.1
- Covered person: means a policyholder, subscriber, or other person participating in a health benefit plan that has a prescription drug benefit managed by a pharmacy benefits manager. See Iowa Code 510B.1
- person: means individual, corporation, limited liability company, government or governmental subdivision or agency, business trust, estate, trust, partnership or association, or any other legal entity. See Iowa Code 4.1
- 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
- Prescription drug order: means the same as defined in section 155A. See Iowa Code 510B.1
- Sale: means any sale, offer for sale, or attempt to sell or lease any land, to the public in this state, for cash or on credit. See Iowa Code 543C.1
2. A pharmacy benefits manager shall not prohibit a pharmacy from disclosing the availability of a lower-cost prescription drug option to a covered person, or from selling a lower-cost prescription drug option to a covered person.