A pharmacy benefits manager performs pharmacy benefits management services for an entity offering pharmacy benefits to the entity's customers, managing prescription drug benefits provided by a covered entity under the term and conditions of a contract between the pharmacy benefits manager and the covered entity.  A pharmacy benefits manager does not include a health insurer licensed in the state if the health insurer or its subsidiary is providing pharmacy benefits management services exclusively to its own insureds, a public self-funded pool, or a private single employer self-funded plan that provides such benefits or services directly to its beneficiaries.

A pharmacy benefits manager doing business in Iowa must obtain a certificate as a third-party administrator under Iowa Code chapter 510, and the provisions relating to a third-party administrator pursuant to Iowa Code chapter 510 shall apply to a pharmacy benefits manager.

A pharmacy benefits manager must provide to the Iowa Insurance Division a quarterly report of all complaints as defined in Iowa Administrative Code rule 191-59.2.  The quarterly report must include all of the information required in Iowa Administrative Code rule 191-59.8.  If further information is needed regarding a quarterly complaint report, select the Pharmacy Benefits Manager contact form from the 'category' drop down menu.

A pharmacy benefits manager must also provide an annual report and include all information in Iowa Code section 510C.2.  The report is available on and must be filed through Opt-Ins by February 15th annually.

Each health carrier, health benefit plan, and pharmacy benefits manager is required to create, use, and submit a single prior authorization form to the commissioner for approval.  The following prior authorization forms have been approved by the Iowa Insurance Division:

Click here for a listing of registered pharmacy benefits managers in Iowa or view the data set below.

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If you need assistance, please contact the Iowa Insurance Division.