Iowa Code 510B.6 – Substitute prescription drugs
Current as of: 2024 | Check for updates
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Terms Used In Iowa Code 510B.6
- Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
- following: when used by way of reference to a chapter or other part of a statute mean the next preceding or next following chapter or other part. See Iowa Code 4.1
- 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
- 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
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
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