The terms defined in Iowa Code sections
510.11,
510B.1, and
510C.1 shall have the same
meaning for the purposes of this chapter. The definitions contained in
191-Chapter 58, "Third-Party Administrators," and 191-Chapter 78, "Uniform
Prescription Drug Information Card," are incorporated by reference. As used in
this chapter:
"Complaint" means a written communication
from a pharmacy or the commissioner to a pharmacy benefits manager that makes
an inquiry or expresses a grievance and includes, but is not limited to, the
following:
1. A comment on, contest or
appeal by a pharmacy of a pharmacy benefits manager's maximum allowable cost,
maximum allowable cost list or other pricing methodology used to pay a
pharmacy.
2. Any pharmacy's appeal
or request for an independent third-party review of an audit report pursuant to
subrules 59.4(4) and 59.4(5).
3.
Any request by a pharmacy for an independent third-party review of a
termination or suspension decision pursuant to paragraph
59.6(3)"d."
4. Any
inquiries from the commissioner pursuant to subrule 59.8(3).
"Day" means a calendar day, unless otherwise
defined or limited.
"Dosage unit" means the same as defined in
45 CFR Section
149.710.
"Ingredient costs" means the costs of the
component of the prescription drug for prescriptions dispensed. Ingredient
costs do not include dispensing fees, copayments received by the pharmacy,
service fees or any other type of reimbursement paid to the pharmacy by a
pharmacy benefits manager.
"Paid" means the later of either the day on
which the payment is mailed by the pharmacy benefits manager or the day on
which the electronic payment is processed by the pharmacy benefits manager's
bank.
"Prescription drug cost reimbursement fee"
means the dollar amount reimbursed by a third-party payor to the pharmacy
benefits manager for the ingredient costs of a prescription drug. The
prescription drug cost reimbursement fee may be a type of third-party payor
administrative service fee.
"Wholesale acquisition cost" means the same
as defined in 42 U.S.C.
Section
1395w-3a(c)(6)(B).
Notes
Iowa Admin. Code r. 191-59.2
ARC 1466C, IAB
5/28/2014, effective 7/2/2014
Amended by
IAB
April 27, 2016/Volume XXXVIII, Number 22, effective
6/1/2016
Amended by
IAB
February 8, 2023/Volume XLV, Number 16, effective
3/15/2023
Amended by
IAB
June 14, 2023/Volume XLV, Number 25, effective
7/19/2023
