Stricken language would be deleted from and underlined language would be added to present law.
Act 333 of the Regular Session
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State of Arkansas 1
94th General Assembly A Bill 2
Regular Session, 2023 HOUSE BILL 1481 3
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By: Representative Achor 5
By: Senator J. Boyd 6
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For An Act To Be Entitled 8
AN ACT TO CREATE THE HEALTHCARE INSURER S HARE THE 9
SAVINGS ACT; TO CREA TE THE ARKANSAS PHAR MACY BENEFITS 10
MANAGER SHARE THE SA VINGS ACT; AND FOR O THER 11
PURPOSES. 12
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14
Subtitle 15
TO CREATE THE HEALTHCARE INSURER SHARE 16
THE SAVINGS ACT; AND TO CREA TE THE 17
ARKANSAS PHARMACY BENEFITS MANAGER SHARE 18
THE SAVINGS ACT. 19
20
21
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 22
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SECTION 1. Arkansas Code Title 23, Chapter 79, is amended to add an 24
additional subchapter to read as follows: 25
26
Subchapter 24 — Healthcare Insurer Share the Savings Act 27
28
23-79-2401. Title. 29
This subchapter shall be known and may be cited as the "Healthcare 30
Insurer Share the Savings Act". 31
32
23-79-2402. Definitions. 33
As used in this subchapter: 34
(1) "Defined cost sharing" means a deductible payment or 35
coinsurance amount imposed on an enrollee for a covered prescription drug 36 HB1481
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under the enrollee’s health benefit plan; 1
(2) "Enrollee” means an individual entitled to coverage of 2
healthcare services from a healthcare insurer; 3
(3)(A) "Health benefit plan" means any individual, blanket, or 4
group plan, policy, or contract for healthcare services issued or delivered 5
by a healthcare insurer in this state. 6
(B) "Health benefit plan" does not include: 7
(i) Accident-only plans; 8
(ii) Specified disease plans; 9
(iii) Disability income plans; 10
(iv) Plans that provide only for indemnity for 11
hospital confinement; 12
(v) Long-term-care-only plans that do not include 13
pharmacy benefits; 14
(vi) Other limited-benefit health insurance policies 15
or plans; 16
(vii) Health benefit plans provided under Arkansas 17
Constitution, Article 5, § 32, the Workers' Compensation Law, § 11 -9-101 et 18
seq., or the Public Employee Workers' Compensation Act, § 21 -5-601 et seq.; 19
or 20
(viii) Any state or local governmental employee 21
plan; 22
(4)(A) "Healthcare insurer" means a: 23
(i) Health insurance issuer that: 24
(a) Is subject to state law regulating 25
insurance; and 26
(b) Offers health insurance coverage under 42 27
U.S.C. § 300gg-91, as it existed on January 1, 2023; 28
(ii) Health maintenance organization; or 29
(iii) Hospital and medical service corporation. 30
(B) "Healthcare insurer" does not include an entity that 31
provides only dental benefits or eye and vision car e benefits; 32
(5) "Price protection rebate" means a negotiated price 33
concession that accrues directly or indirectly to a healthcare insurer, or 34
other party on behalf of the healthcare insurer, if there is an increase in 35
the wholesale acquisition cost of a prescription drug above a specified 36 HB1481
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threshold; and 1
(6) "Rebate" means: 2
(A) A negotiated price concession, including without 3
limitation base price concessions, whether described as a rebate or not, 4
reasonable estimates of any price protection reba tes, and performance -based 5
price concessions that may accrue, directly or indirectly, to the healthcare 6
insurer during the coverage year from a manufacturer or other party in 7
connection with the dispensing or administration of a prescription drug; and 8
(B) Any reasonable estimate of a negotiated price 9
concession, fee, and other administrative cost that is passed through, or is 10
reasonably anticipated to be passed through, to the healthcare insurer and 11
serves to reduce the healthcare insurer’s liabilities for a prescription 12
drug. 13
14
23-79-2403. Implementation of subchapter — Requirements. 15
(a) An enrollee’s defined cost sharing for a prescription drug shall 16
be calculated at the point -of-sale based on a price that is reduced by an 17
amount equal to at least o ne hundred percent (100%) of all rebates received, 18
or to be received, in connection with the dispensing or administration of the 19
prescription drug. 20
(b) This subchapter shall not preclude a healthcare insurer from 21
decreasing an enrollee's defined cost sha ring by an amount greater than that 22
required under subsection (a) of this section. 23
(c) In implementing the requirements of this section, the state shall 24
only regulate a healthcare insurer to the extent permissible under applicable 25
law. 26
(d)(1) In complying with this section, a healthcare insurer or its 27
agents shall not publish or otherwise reveal information regarding the actual 28
amount of rebates a healthcare insurer receives on a product or therapeutic 29
class of products, manufacturer, or pharmacy -specific basis. 30
(2) The information described in subdivision (d)(1) of this 31
section is: 32
(A) Protected as a trade secret; 33
(B) Considered proprietary and confidential under § 23 -61-34
107(a)(4) and § 23-61-207; 35
(C) Not subject to disclosure under the Freedom of 36 HB1481
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Information Act of 1967, § 25 -19-101 et seq.; and 1
(D) Not to be disclosed: 2
(i) Directly or indirectly; or 3
(ii) In a manner that would: 4
(a) Allow for the identification of an 5
individual product, therapeutic class of products, or manufacturer; or 6
(b) Have the potential to compromise the 7
financial, competitive, or proprietary nature of the information. 8
(3) A healthcare insurer shall impose the confidentiality 9
protections of this section on any vendor or downstream third party that 10
performs healthcare or administrative services on behalf of the healthcare 11
insurer that may receive or have access to rebate information. 12
13
SECTION 2. Arkansas Code Title 23, Chapter 92, is amended to a dd an 14
additional subchapter to read as follows: 15
16
Subchapter 7 — Arkansas Pharmacy Benefits Manager Share the Savings Act 17
18
23-92-701. Title. 19
This subchapter shall be known and may be cited as the "Arkansas 20
Pharmacy Benefits Manager Share the Savings Act" . 21
22
23-92-702. Purpose. 23
The purpose of this subchapter is to require pharmacy benefits managers 24
to share the benefit of rebates with enrollees in this state. 25
26
23-92-703. Definitions. 27
As used in this subchapter: 28
(1) "Defined cost sharing" means a de ductible payment or 29
coinsurance amount imposed on an enrollee for a covered prescription drug 30
under the enrollee’s health benefit plan; 31
(2) "Enrollee” means an individual entitled to coverage of 32
healthcare services from a healthcare insurer; 33
(3)(A) "Health benefit plan" means any individual, blanket, or 34
group plan, policy, or contract for healthcare services issued or delivered 35
by a healthcare insurer in this state. 36 HB1481
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(B) "Health benefit plan" does not include: 1
(i) Accident-only plans; 2
(ii) Specified disease plans; 3
(iii) Disability income plans; 4
(iv) Plans that provide only for indemnity for 5
hospital confinement; 6
(v) Long-term-care-only plans that do not include 7
pharmacy benefits; 8
(vi) Other limited-benefit health insur ance policies 9
or plans; 10
(vii) Health benefit plans provided under Arkansas 11
Constitution, Article 5, § 32, the Workers' Compensation Law, § 11 -9-101 et 12
seq., or the Public Employee Workers' Compensation Act, § 21 -5-601 et seq.; 13
or 14
(viii) Any state or local governmental employee 15
plan; 16
(4) "Healthcare insurer" means an insurance company that is 17
subject to state law regulating insurance including without limitation a 18
health maintenance organization or a hospital and medical service 19
corporation; 20
(5) "Pharmacy benefits management service" means a service to: 21
(A) Negotiate the price of prescription drugs, including 22
negotiating and contracting for direct or indirect rebates, discounts, or 23
other price concessions; 24
(B) Manage any aspect of a pr escription drug benefit, 25
including without limitation: 26
(i) Claims processing services; 27
(ii) The performance of drug utilization review; 28
(iii) The processing of drug prior authorization 29
requests; 30
(iv) The adjudication of appeals or grie vances 31
related to a prescription drug benefit; 32
(v) Controlling the cost of covered prescription 33
drugs; or 34
(vi) The provision of services related to the 35
services described under this subdivision (5)(B); 36 HB1481
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(C) Disburse or distribute rebates, man age or participate 1
in incentive programs or arrangements for pharmacist services, negotiate or 2
enter into contractual arrangements with pharmacists or pharmacies, or both, 3
develop formularies, or employ advertising or promotional services; 4
(D) Perform any other administrative, managerial, 5
clinical, pricing, financial, reimbursement, or billing service; and 6
(E) Perform any other services as the Insurance 7
Commissioner may include by rule; 8
(6)(A) "Pharmacy benefits manager" means a person, business, or 9
entity that, pursuant to a written agreement with a healthcare insurer or 10
health benefit plan, either directly or indirectly provides one (1) or more 11
pharmacy benefits management services on behalf of the healthcare insurer or 12
health benefit plan, and any agent, contractor, intermediary, affiliate, 13
subsidiary, or related entity of the person, business, or entity that 14
facilitates, provides, directs, or oversees the provision of the pharmacy 15
benefits management service or services. 16
(B) "Pharmacy benefits manager" does not include a: 17
(i) Healthcare facility licensed in Arkansas; 18
(ii) Healthcare professional licensed in Arkansas; 19
or 20
(iii) Consultant who only provides advice as to the 21
selection or performance of a pha rmacy benefits manager; 22
(7) "Price protection rebate" means a negotiated price 23
concession that accrues directly or indirectly to a healthcare insurer, or 24
other party on behalf of the healthcare insurer, if there is an increase in 25
the wholesale acquisiti on cost of a prescription drug above a specified 26
threshold; and 27
(8) "Rebate" means: 28
(A) A negotiated price concession including without 29
limitation base price concessions, whether described as a rebate or not, 30
reasonable estimates of any price protec tion rebates, and performance -based 31
price concessions that may accrue, directly or indirectly, to the healthcare 32
insurer during the coverage year from a manufacturer or other party in 33
connection with the dispensing or administration of a prescription drug; and 34
(B) Any reasonable estimate of a negotiated price 35
concession, fee, and other administrative cost that is passed through, or is 36 HB1481
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reasonably anticipated to be passed through, to the healthcare insurer and 1
serves to reduce the healthcare insurer’s lia bilities for a prescription 2
drug. 3
4
23-92-704. Implementation of subchapter — Requirements. 5
(a) An enrollee’s defined cost sharing for a prescription drug shall 6
be calculated at the point -of-sale based on a price that is reduced by an 7
amount equal to at least one hundred percent (100%) of all rebates received, 8
or to be received, in connection with the dispensing or administration of the 9
prescription drug. 10
(b) This subchapter shall not preclude a pharmacy benefits manager 11
from decreasing an enrollee’ s defined cost sharing by an amount greater than 12
that required under subsection (a) of this section. 13
(c)(1) A pharmacy benefits manager shall submit a certification to the 14
Insurance Commissioner by January 1 of each calendar year certifying that the 15
pharmacy benefits manager has complied with the requirements of this section 16
during the previous calendar year. 17
(2) The certification under subdivision (c)(1) of this section 18
shall be signed by the chief executive officer or chief financial officer of 19
the pharmacy benefits manager. 20
(3) The form of the certification shall: 21
(A) Be in a format approved or established by the 22
commissioner; and 23
(B) Include the pharmacy benefits manager’s best estimate 24
of the aggregate amount of rebates used to reduc e enrollee-defined cost 25
sharing for prescription drugs in the previous calendar year based on 26
information known to the pharmacy benefits manager as of the date of the 27
certification. 28
(d)(1) In complying with this section, a pharmacy benefits manager or 29
its agents shall not publish or otherwise reveal information regarding the 30
actual amount of rebates a pharmacy benefits manager receives on a product or 31
therapeutic class of products, manufacturer, or pharmacy -specific basis. 32
(2) The information describe d in subdivision (d)(1) of this 33
section is: 34
(A) Protected as a trade secret; 35
(B) Considered proprietary and confidential under § 23 -61-36 HB1481
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107(a)(4) and § 23-61-207; 1
(C) Not subject to disclosure under the Freedom of 2
Information Act of 1967, § 25-19-101 et seq.; and 3
(D) Not to be disclosed: 4
(i) Directly or indirectly; or 5
(ii) In a manner that would: 6
(a) Allow for the identification of an 7
individual product, therapeutic class of products, or manufacturer; or 8
(b) Have the potential to compromise the 9
financial, competitive, or proprietary nature of the information. 10
(3) A pharmacy benefits manager shall impose the confidentiality 11
protections of this section on any vendor or downstream third party that 12
performs healthcare services or administrative services on behalf of the 13
pharmacy benefits manager that may receive or have access to rebate 14
information. 15
16
SECTION 3. DO NOT CODIFY. Severability. 17
(a) In implementing this act, the state shall regulate a health 18
benefit plan, healthcare insurer, or pharmacy benefits manager only to the 19
extent permissible under applicable law. 20
(b)(1) The provisions of this act are severable. 21
(2) The invalidity of any provision of this act shall not affect 22
other provisions of this act that can be given effect without the invalid 23
provision. 24
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APPROVED: 3/21/23 27
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