Current Legislative Issues

Rules regulating PBMs operating in the state of Iowa were recently adopted by the Administrative Rules Review Committee. 

IPA has worked with the Iowa Insurance Division and other interested parties for a year and a half to draft the final rules.  While the PBM rules do not address every issue, IPA feels they are a step in the right direction.  As mandated in Senate File 512, passed during the 2007 Legislative Session, the rules address prompt payment, auditing practices, and adjudication of claims.  PBMs are required to reimburse pharmacies within 20 days for clean electronic claims and 30 days for clean written claims.  This will take effect as PBM contracts are renewed, no later than December 31^, 2009.  A study will also be completed by December 31, 2009 looking into the feasibility of moving to a 15 day prompt payment standard.  The auditing section sets guidelines for when PBMs can conduct audits, requires a PBM to provide the pharmacy documentation proving overpayment before recouping funds, and establishes an appeal process.  The auditing section applies to all claims submitted after December 31, 2008.  

Click here to read the adopted rules.