§ 510D.2 — 340B drug program — contract pharmacies and covered entities

Iowa § 510D.2

• Jurisdiction: Iowa
• Title XIII: COMMERCE
• Ch. 510D: 340B PROGRAM — COVERED ENTITIES AND CONTRACT PHARMACIES

Text

1. Group health plans, health carriers that offer group or individual health insurance
coverage, third-party administrators, and pharmacy benefits managers shall not discriminate
against a covered entity or a contract pharmacy by reimbursing the covered entity or the
contract pharmacy for a prescription drug or a dispensing fee in an amount less than the
group health plan, health carrier, third-party administrator, or pharmacy benefits manager
reimburses a similarly situated entity or pharmacy that is not a covered entity or a contract
pharmacy.
2. a. Group health plans, health carriers that offer group or individual health insurance
coverage, third-party administrators, and pharmacy benefits managers shall not, on the basis
that an entity is a covered entity or that a pharmacy is a contract pharmacy, or that a covered
entity or contract pharmacy participate in the 340B program, impose any of the following
contractual terms and conditions on the covered entity or the contract pharmacy that differ
from those imposed on a similarly situated entity or pharmacy that is not a covered entity or
a contract pharmacy:
(1) FeesorotherassessmentsthatarenotrequiredbystatelawortheIowaadministrative
code.
(2) Chargebacks, clawbacks, or other reimbursement adjustments that are not required
by state law or the Iowa administrative code.
(3) Professional dispensing fees that are not required by state law or the Iowa
administrative code.
(4) Restrictions or requirements related to participation in standard or preferred
pharmacy networks.
(5) Requirements related to the frequency or scope of audits.
§510D.2, 340B PROGRAM — COVERED ENTITIES AND CONTRACT PHARMACIES 2
(6) Requirements related to inventory management systems that utilize generally
accepted accounting principles.
(7) Requirements related to mandatory disclosure either directly or through a third party,
except disclosures required by federal law, of prescription orders that are filled with covered
outpatient drugs obtained through the 340B program.
b. Paragraph “a”, subparagraphs (1) and (2), shall not be construed to prohibit
adjustments for overpayments or other errors associated with an adjudicated claim.
c. Paragraph “a”, subparagraph (7), shall not be construed to prohibit modifiers or other
identifiers on claims to identify whether a drug was purchased through the 340B program or
to prevent duplication of rebates.
3. Group health plans, health carriers that offer group or individual health insurance
coverage, third-party administrators, and pharmacy benefits managers shall not do any of
the following on the basis that an entity is a covered entity or that a pharmacy is a contract
pharmacy, or that a covered entity or a contract pharmacy participates in the 340B program:
a. Place any restrictions or impose any requirements on an individual that chooses to
obtain a covered outpatient drug from a covered entity or a contract pharmacy, whether in
person, via courier or the United States post office, or any other form of delivery.
b. Refuse to contract with a covered entity or a contract pharmacy based on any criteria
that is not applied equally to a contract with a similarly situated entity or pharmacy that does
not participate in the 340B drug program.
c. Impose any restriction or condition on a covered entity that interferes with the covered
entity’s ability to maximize the value of the discounts obtained by the covered entity through
the covered entity’s participation in the 340B drug program.