Iowa Code § 510B.8C

Current through March 29, 2024

Section 510B.8C - Clean claims

After the date of receipt of a clean claim submitted by a pharmacy in a pharmacy network, a pharmacy benefits manager shall not retroactively reduce payment on the claim, either directly or indirectly except in the following circumstances:

1. The claim is found not to be a clean claim during the course of a routine audit.

2. The claim submission was fraudulent.

3. The claim submission was a duplicate submission of a claim for which the pharmacy had already received payment.

Iowa Code § 510B.8C

2022 Acts, ch 1113, §10, 16, 23

Added by 2022 Iowa, ch 1113, s 9, eff. 6/13/2022, app. to pharmacy benefits managers that manage a prescription drug benefit in the state on or after 6/13/2022.

Section applies to pharmacy benefits managers that manage a prescription drug benefit in the state on or after June 13, 2022; 2022 Acts, ch 1113, §16