Iowa Admin. Code r. 191-59.9

Current through Regsiter Vol. 46, No. 26, June 12, 2024
Rule 191-59.9 - Duty to notify commissioner of fraud

A third-party payor that contracts with a pharmacy benefits manager to perform the third-party payor's services shall require the pharmacy benefits manager to follow Iowa Code section 507E.6 in notifying the commissioner of any detection of fraud, including but not limited to prescription drug diversion activity. "Prescription drug diversion activity," for purposes of this rule, means the diversion of prescription drugs from legal and medically necessary uses to uses that are illegal and not medically authorized or necessary. A pharmacy benefits manager shall follow the fraud detection protocol developed by the third-party payor or shall allow the third-party payor to review and agree to the pharmacy benefits manager's protocol.

Iowa Admin. Code r. 191-59.9

ARC 1466C, IAB 5/28/2014, effective 7/2/2014
ARC 2518C, IAB 4/27/16, effective 6/1/16
Amended by IAB February 8, 2023/Volume XLV, Number 16, effective 3/15/2023