510C.1 Definitions.
As used in this chapter unless the context otherwise requires:
1. “Administrative fees” means a fee or payment, other than a rebate, under a contract between a pharmacy benefits manager and a pharmaceutical drug manufacturer in connection with the pharmacy benefits manager’s management of a health carrier’s prescription drug benefit, that is paid by a pharmaceutical drug manufacturer to a pharmacy benefits manager or is retained by the pharmacy benefits manager.
2. “Aggregate retained rebate percentage” means the percentage of all rebates received by a pharmacy benefits manager that is not passed on to the pharmacy benefits manager’s health carrier clients.
3. “Commissioner” means the commissioner of insurance.
4. “Covered person” means the same as defined in section 514J.102.
5. “Formulary” means a complete list of prescription drugs eligible for coverage under a health benefit plan.
6. “Health benefit plan” means the same as defined in section 514J.102.
7. “Health carrier” means the same as defined in section 514J.102.
8. “Health carrier administrative service fee” means a fee or payment under a contract between a pharmacy benefits manager and a health carrier in connection with the pharmacy benefits manager’s administration of the health carrier’s prescription drug benefit that is paid by a health carrier to a pharmacy benefits manager or is otherwise retained by a pharmacy benefits manager.
9. “Pharmacy benefits manager” means a person who, pursuant to a contract or other relationship with a health carrier, either directly or through an intermediary, manages a prescription drug benefit provided by the health carrier.
10. “Prescription drug benefit” means a health benefit plan providing for third-party payment or prepayment for prescription drugs.
11. “Rebate” means all discounts and other negotiated price concessions paid directly or indirectly by a pharmaceutical manufacturer or other entity, other than a covered person, in the prescription drug supply chain to a pharmacy benefits manager, and which may be based on any of the following:
a. A pharmaceutical manufacturer’s list price for a prescription drug.
b. Utilization.
c. To maintain a net price for a prescription drug for a specified period of time for the pharmacy benefits manager in the event the pharmaceutical manufacturer’s list price increases.
d. Reasonable estimates of the volume of a prescribed drug that will be dispensed by a pharmacy to covered persons.
2019 Acts, ch 88, §1; 2020 Acts, ch 1063, §279 – 281
Subsections 1, 2, 8, and 9 amended
Subsection 11, unnumbered paragraph 1 amended
Subsection 11, paragraph c amended