Iowa Board of Pharmacy Rules Regarding Pharmacy Benefit Managers

Pharmacy Benefit Managers
Today, more than 210 million Americans nationwide receive drug benefits administered by pharmacy benefit managers (PBMs). It is estimated that there are fewer than 100 major
IA Vol. 27, No. 2

PBM companies in the United States. The Iowa Board of Pharmacy office routinely receives numerous questions about the activities of PBMs. In Iowa, PBMs are regulated by the Iowa Department of Commerce, Insurance Division. Current law resides in Iowa Code, Chapter 510B and administrative rules are located in 191 Iowa Administrative Code, Chapter 59. The law and rules have been in effect since 2007-2008. A copy of Iowa law and rules for PBMs is included as an insert to this issue of the Newsletter. PBMs are required to obtain the approval of the prescribing practitioner prior to request- ing any drug substitution under Iowa Code §510B.6. A PBM may not substitute an equivalent prescription drug contrary to a prescription drug order that prohibits a substitution. PBMs are required to develop an internal system to record and report complaints. These requirements are contained in 191 I.A.C. 59.5(1). The Iowa Insurance Division has drafted some specific instructions for pharmacists who wish to file a complaint against a PBM, which are available online at www .iid.state.ia.us/file_a_complaint. PBMs are required to submit a summary of all complaints filed against them with the Iowa commissioner of insurance on a quarterly basis. Forty-eight PBMs are listed in the online directory of the Pharmacy Benefit Management Institute at www.pbmi.com/pbmdir.asp. None of these companies are located in Iowa. In 2012, the five largest PBMs in the US were Express Scripts of St Louis, MO; CVS Caremark of Scottsdale, AZ; Prime Therapeutics of Eagan, MN; OptumRx of Irvine, CA; and Catamaran of Lisle, IL.

quoted from Iowa Board of Pharmacy September 2013 Newsletter