IOW INS Timely Payment of Claims

Updated on: Feb 9, 2025

Latest Event


  • Feb. 5, 2025 IOW INS Public Hearing
  • On Feb. 5, 2025, IOW INS reported a public hearing on the regulatory analysis related to Chapter 59, Pharmacy Benefits Managers, will be held on Feb. 28, 2025, at 11 a.m.
  • Noted oral or written comments are due on or before 4:30 p.m. on Feb. 28, 2025.

On Nov. 27, IOW INS proposed updating pharmacy benefit claims.

  • IOW INS issued Notice of intended proposal on timely payment of pharmacy claims.
  • This proposed rulemaking is also published as an Adopted and Filed Emergency Rule.
  • The purpose of this Notice of Intended Action is to solicit public comment on that emergency rulemaking, whose subject matter is adopted by reference and published.
  • Highlights
  • Rule, intended proposal amends IOW INS 191-59, Pharmacy Benefits Managers (PBM).
  • Amendments reflect changes necessary to conform with statutory provisions and reduce harm to public welfare by ensuring the timely payment of pharmacy claims.
  • A pharmacy benefits manager shall not retroactively reduce reimbursement, through adjustment or reconciliation or any other means, of a clean claim paid to pharmacies.
  • Consultation
  • A public hearing on the intended proposal will be held Dec. 19, 2024 10 to 11 a.m.
  • Comments on proposal must be submitted on or before 4:30 p.m. on Dec. 19, 2024.
  • Effectiveness
  • This Emergency rulemaking will become effective on Nov. 27, 2024.
  • Feb. 5, 2025 IOW INS Adopted Rule
  • On Feb. 5, 2025, IOW INS published adopted and filed rulemaking in State register.
  • This rulemaking was adopted by IOW INS Commissioner Ommen on Jan. 14, 2025.
  • Adopted rule amends IOW INS 191-59.3(510B) Timely payment of pharmacy claims.
  • Final rule effective on Mar. 12, 2025, at which time emergency rulemaking rescinded.
  • Feb. 5, 2025 IOW INS Public Hearing
  • On Feb. 5, 2025, IOW INS reported a public hearing on the regulatory analysis related to Chapter 59, Pharmacy Benefits Managers, will be held on Feb. 28, 2025, at 11 a.m.
  • Noted oral or written comments are due on or before 4:30 p.m. on Feb. 28, 2025.
Regulators
IOW INS
Entity Types
Ins
Reference
Nt, IOW SR Vol. XLVII, No. 16, p. 8716, 2/5/2025; IOW SR Vol. XLVII, No. 11, p. 5703, 5948, 11/27/2024; RF ARC 8427C, Nt ARC 8429C, 11/27/2024; Citation: IOW INS 191-59;
Functions
Claims/Accelerated Benefits; Compliance; Reporting
Countries
United States of America
Category
State
N/A
Products
Insurance; Insurance-Health
Rule Type
Final
Regions
Am
Rule Date
Nov 27, 2024
Effective Date
Feb 28, 2025
Rule ID
235030
Linked to
N/A
Reg. Last Update
Feb 5, 2025
Report Section
US Insurance