Iowa Administrative Code › Agency 191 - Insurance Division › Health Benefit Plans › Chapter 78 - Uniform Prescription Drug Information Card › Rule 191-78.2 - Definitions

Current through Register Vol. 47, No. 3, July 24, 2024
"Administrator"
or
"administrator of
				  the payor"
means the claims administrator or administrators to which
				  claims for prescription drug benefits are submitted, processed and adjudicated,
				  and includes pharmacy benefit managers, and excludes administrators for
				  self-funded employer-sponsored health benefit plans qualified under the federal
				  Employee Retirement Income Security Act of 1974.
"BIN number," "IIN/BIN number," "BIN,"
or
"RxBIN"
means the ANSI-assigned issuer identification number,
				  or IIN, which was formerly known as the "bank identification number" or "BIN,"
				  and which is identified in the National Council for Prescription Drug Programs
				  Pharmacy ID Card Implementation Guide as the "BIN number." The "Rx" prefix is
				  not required if the same BIN number is used for pharmacy and medical claims
				  submission.
"Card"
or
"card or other technology
				  for claims processing"
means a card or other technology that is issued
				  to insureds, enrollees, and covered individuals. Insureds, enrollees, and
				  covered individuals provide the card to pharmacies to receive prescription drug
				  benefits. Pharmacies use the information, required by Iowa Code chapter 514L to
				  be on the card, for prescription drug claims submission, processing and
				  adjudication with providers, administrators, pharmacy benefit managers or
				  similar entities.
"Cardholder ID"
means the cardholder's
				  unique identification number that is issued by the provider to the insured,
				  enrollee, or covered individual, and which is identified in the National
				  Council for Prescription Drug Programs Pharmacy ID Card Implementation
				  Guide.
"Cardholder name"
means the cardholder's
				  first name, middle initial and last name.
"Card issuer identifier number"
means the
				  number identified in the National Council for Prescription Drug Programs
				  Pharmacy ID Card Implementation Guide as the international identifier for the
				  United States of America, which has not yet been enumerated and may remain
				  blank on cards until such number is determined.
"Card issuer's name and logo"
means the name
				  and identifying mark of the entity issuing the card or other technology,
				  identified in the National Council for Prescription Drug Programs Pharmacy ID
				  Card Implementation Guide.
"Consistent with the guide"
means that the
				  information and data elements on the card shall conform to the standards set
				  forth in the most recent release of the National Council for Prescription Drug
				  Programs Pharmacy ID Card Implementation Guide, except that the address of the
				  pharmacy benefit manager may be excluded and the information and data elements
				  may be placed at different locations on the card as reasonably necessary to
				  accommodate space and logistical needs.
"Group ID number, " "Grp,"
or
"RxGrp"
means the group identification number or group ID
				  number as identified in the National Council for Prescription Drug Programs
				  Pharmacy ID Card Implementation Guide. The "Rx" prefix is not required if the
				  same group number is used for pharmacy and medical claims submission.
"Guide"
or
"National Council for
				  Prescription Drug Programs Pharmacy ID Card Implementation Guide"
means the most recent document issued by the National Council for Prescription
				  Drug Programs.
"Pharmacy benefit manager"
means an entity
				  that receives and processes claims for payment or prepayment for prescription
				  drug expenses from pharmacies and that may issue cards or other technology for
				  prescription claims processing.
"Processor control number," "PCN,
"or
"RxPCN"
means the processor control number as identified in
				  the National Council for Prescription Drug Programs Pharmacy ID Card
				  Implementation Guide. The "Rx" prefix is not required if the same PCN number is
				  used for pharmacy and medical claims submission.
"Provider of third-party payment or prepayment of
				  prescription drug expenses"
or
"provider"
means a
				  provider of an individual or group policy of accident or health insurance or an
				  individual or group hospital or health care service contract issued pursuant to
				  Iowa Code chapter 509, 514 or 514A, a provider of a plan established pursuant
				  to Iowa Code chapter 509A for public employees, a provider of an individual or
				  group health maintenance organization contract issued and regulated under Iowa
				  Code chapter 514B, a provider of a preferred provider contract issued pursuant
				  to Iowa Code chapter 514F, a provider of a self-insured multiple employer
				  welfare arrangement, and any other entity providing health insurance or health
				  benefits which provide for payment or prepayment of prescription drug expenses
				  coverage subject to state insurance regulation.
"Substantially consistent with the guide"
means that the location of the uniform prescription drug information on the
				  card or other technology shall conform to the standards set forth in the most
				  recent National Council for Prescription Drug Programs Pharmacy ID Card
				  Implementation Guide. The information may be placed at different locations on
				  the card as reasonably necessary to accommodate space and logistical
				  needs.
"Uniform prescription drug information"
means the requirements set forth in the most recent National Council for
				  Prescription Drug Programs Pharmacy ID Card Implementation Guide, including the
				  data elements information required on the card, such as the content, format and
				  the location.