2009 Iowa Code
Title 13 - Commerce
Subtitle 1 - Insurance and Related Regulation
CHAPTER 510B - REGULATION OF PHARMACY BENEFITS MANAGERS
510B.1 - DEFINITIONS.

        510B.1  DEFINITIONS.
         As used in this chapter, unless the context otherwise requires:
         1.  "Commissioner" means the commissioner of insurance.
         2.  "Covered entity" means a nonprofit hospital or medical
      services corporation, health insurer, health benefit plan, or health
      maintenance organization; a health program administered by a
      department or the state in the capacity of provider of health
      coverage; or an employer, labor union, or other group of persons
      organized in the state that provides health coverage.  "Covered
      entity" does not include a self-funded health coverage plan that is
      exempt from state regulation pursuant to the federal Employee
      Retirement Income Security Act of 1974 (ERISA), as codified at 29
      U.S.C. § 1001 et seq.; a plan issued for health coverage for federal
      employees; or a health plan that provides coverage only for
      accidental injury, specified disease, hospital indemnity, Medicare
      supplemental, disability income, or long-term care, or other limited
      benefit health insurance policy or contract.
         3.  "Covered individual" means a member, participant,
      enrollee, contract holder, policyholder, or beneficiary of a covered
      entity who is provided health coverage by the covered entity, and
      includes a dependent or other person provided health coverage through
      a policy, contract, or plan for a covered individual.
         4.  "Generic drug" means a chemically equivalent copy of a
      brand-name drug with an expired patent.
         5.  "Labeler" means a person that receives prescription drugs
      from a manufacturer or wholesaler and repackages those drugs for
      later retail sale and that has a labeler code from the federal food
      and drug administration pursuant to 21 C.F.R. § 207.20.
         6.  "Pharmacy" means pharmacy as defined in section 155A.3.
         7.  "Pharmacy benefits management" means the administration or
      management of prescription drug benefits provided by a covered entity
      under the terms and conditions of the contract between the pharmacy
      benefits manager and the covered entity.
         8.  "Pharmacy benefits manager" means a person who performs
      pharmacy benefits management services.  "Pharmacy benefits
      manager" includes a person acting on behalf of a pharmacy benefits
      manager in a contractual or employment relationship in the
      performance of pharmacy benefits management services for a covered
      entity.  "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, or a public self-funded pool or a private single
      employer self-funded plan that provides such benefits or services
      directly to its beneficiaries.
         9.  "Prescription drug" means prescription drug as defined in
      section 155A.3.
         10.  "Prescription drug order" means prescription drug order
      as defined in section 155A.3.  

         2007 Acts, ch 193, §1, 9