Stricken language would be deleted from and underlined language would be added to present law.
Act 511 of the Regular Session
*ANS112* 03-13-2025 09:57:51 ANS112
State of Arkansas As Engrossed: H2/5/25 H2/20/25 H3/13/25 1
95th General Assembly A Bill 2
Regular Session, 2025 HOUSE BILL 1301 3
4
By: Representative L. Johnson 5
By: Senator Irvin 6
7
For An Act To Be Entitled 8
AN ACT TO AMEND THE PRIOR AUTHORIZATION TRANSPARENCY 9
ACT; AND FOR OTHER PURPOSES. 10
11
12
Subtitle 13
TO AMEND THE PRIOR AUTHORIZATION 14
TRANSPARENCY ACT. 15
16
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 17
18
SECTION 1. Arkansas Code § 23-99-1103, concerning the definitions used 19
in the Prior Authorization Transparency Act, is amended to add an additional 20
subdivision to read as follows: 21
(23) "Gold card program" means the process described in §§ 23 -22
99-1120 — 23-99-1126 under which a healthcare provider may qualify for an 23
exemption from a healthcare insurer's or pharmacy benefits manager's prior 24
authorization requirements. 25
26
SECTION 2. Arkansas Code § 23 -99-1120 is amended to read as follows: 27
28
23-99-1120. Initial exemption from prior authorization requirements 29
for healthcare providers providing certain healthcare services. 30
(a)(1) Except as provided under subdivision (a)(2) of this section, 31
beginning on and after January 1, 2024, a healthcare provider that received 32
approval for ninety percent (90%) or more of the healthcare provider's prior 33
authorization requests based on a review of the healthcare provider's 34
utilization of the particular healthcare services from January 1, 2022, 35
through June 30, 2022, shall not be required to obtain prior authorization 36 As Engrossed: H2/5/25 H2/20/25 H3/13/25 HB1301
2 03-13-2025 09:57:51 ANS112
for a particular healthcare service and shall be considered exempt from prior 1
authorization requirements through September 30, 2024. 2
(2) If a healthcare provider's use for a particular healthcare 3
service increases by twenty -five percent (25%) or more during the period 4
between January 1, 2024, and June 30, 2024, based on a review of the 5
healthcare provider's utilization of the particular healthcare service from 6
January 1, 2022, through June 30, 2022, then the healthcare insurer may 7
disallow the exemption from prior authorization requirements for the 8
healthcare provider for the particular healthcare service. 9
(b)(1) A healthcare insurer shall conduct an evaluation of the initial 10
six-month exemption period based on claims submitted between January 1, 2024, 11
through June 30, 2024, to determine whether to grant or deny an exemption for 12
each particular healthcare service that requires a prior authorization by the 13
healthcare insurer. 14
(2) The evaluation by the healthcare insurer shall be conducted 15
by using the retrospective review process under § 23 -99-1122(c) and applying 16
the criteria under subsection (d) of this section. 17
(3) A healthcare insurer shall submit to a healthcare provider a 18
written statement of: 19
(A) The total number of payable claims submitted by or in 20
connection with the healthcare provider; and 21
(B) The total number of denied and approved prior 22
authorizations between January 1, 2022, through June 30, 2022. 23
(c)(1) No later than October 1, 2024, a healthcare insurer shall issue 24
a notice to each healthcare provider that either grants or denies a prior 25
authorization exemption to the healthcare provider for each particular 26
healthcare service. 27
(2) An exemption granted under this subdivision (c)(1) shall be 28
valid for at least twelve (12) months. 29
(d) Except as provided under subsection (f) subsection (c) of this 30
section or § 23-99-1125, a healthcare insurer that uses a prior authorization 31
process for healthcare services shall not require a healthcare provider to 32
obtain prior authorization for a particular healthcare service that a 33
healthcare provider has previously been subject to a prior authorization 34
requirement if, in the most recent six -month evaluation period as described 35
under subsection (e) subsection (b) of this section, the healthcare insurer 36 As Engrossed: H2/5/25 H2/20/25 H3/13/25 HB1301
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has approved or would have approved no less than ninety percent (90%) of the 1
prior authorization requests submitted by the healthcare provider for that 2
particular healthcare service. 3
(e)(1)(b)(1) Except as provided under subsection (f) subsection (c) of 4
this section, a healthcare insurer shall evaluate whether or not a healthcare 5
provider qualifies for an exemption from prior authorization requirements 6
under subsection (d) subsection (a) of this section one (1) time every twelve 7
(12) months. 8
(2) The six-month period for the evaluation period described 9
under subsection (d) subsection (a) of this section shall be : 10
(A) For a healthcare provider with an existing exemption 11
under this section, any consecutive six-month period during the twelve (12) 12
months following the effective date of the exemption ; 13
(B) For an initial healthcare provider, any consecutive 14
six-month period during the twelve (12) months following the healthcare 15
provider's first filed claim with the healthcare insurer; 16
(C) For an initial healthcare insurer, any consecutive 17
six-month period during the twelve (12) months following the healthcare 18
insurer's commencement of operations subject to this subchapter; or 19
(D)(i) For a healthcare provider denied an exemption under 20
this section, any consecutive six -month period during the twelve (12) months 21
before the healthcare provider's request for a new evaluation. 22
(ii) A healthcare provider may request that the 23
healthcare insurer perform a new evaluation twelve (12) months after the most 24
recent denial. 25
(3) The healthcare insurer shall choose a six -month evaluation 26
period that allows time for: 27
(A) The evaluation under subsection (d) subsection (a) of 28
this section; 29
(B) Notice to the healthcare provider of the decision; and 30
(C) Appeal of the decision for an independent review to be 31
completed by the end of the twelve -month period of the exemption. 32
(f)(c) A healthcare insurer may continue an exemption under subsection 33
(d) subsection (a) of this section without evaluating whether or not the 34
healthcare provider qualifies for the exemption under subsection (d) 35
subsection (a) of this section for a particular evaluation period. 36 As Engrossed: H2/5/25 H2/20/25 H3/13/25 HB1301
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(g)(d) A healthcare provider is not required to request an exemption 1
under subsection (d) subsection (a) of this section to quality qualify for 2
the exemption. 3
(h)(e)(1) A healthcare insurer may shall extend an exemption under 4
subsection (d) subsection (a) of this section to a group of healthcare 5
providers under the same tax identification number if either the healthcare 6
insurer or the healthcare provider elects to do so, and : 7
(1)(A) A healthcare provider with an ownership interest in 8
the entity to which the tax identification number is assigned does not 9
object; or 10
(2)(B) The tax identification number is associated with a 11
hospital licensed in this state and the chief executive officer of the 12
hospital agrees to the exemption. 13
(2) If a healthcare insurer elects to extend an exemption under 14
subdivision (e)(1) of this section to a group of healthcare providers, the 15
healthcare insurer shall provide to each affected healthcare provider at 16
least sixty (60) days' prior notice of the election and of any modification 17
to or termination of the election. 18
(3) If, in the most recent six -month evaluation period, the 19
healthcare insurer approved or would have approved less than eighty percent 20
(80%) of the prior authorization requests submitted by a healthcare provider 21
for a particular healthcare service, the healthcare provider shall not be 22
eligible for inclusion under an exemption extended to healthcare providers 23
under the same tax identification number under this subsection. 24
25
SECTION 3. Arkansas Code § 23 -99-1121(a), concerning the duration of a 26
prior authorization exemption under the Prior Authorization Transparency Act, 27
is amended to read as follows: 28
(a) Unless a prior authorization exemption is continued for a longer 29
period of time by a healthcare insurer under § 23-99-1120(f) § 23-99-1120(c), 30
a healthcare provider's exemption from prior authorization requirements under 31
§ 23-99-1120 remains in effect until the later of: 32
(1) The thirtieth day after the date the healthcare insurer 33
notifies the healthcare provider of the healthcare insurer's determination to 34
rescind the exemption as described under § 23 -99-1122, if the healthcare 35
provider does not appeal the healthcare insurer's determination within thirty 36 As Engrossed: H2/5/25 H2/20/25 H3/13/25 HB1301
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(30) days of notification of the determination; 1
(2) If the healthcare provider appeals the determination within 2
thirty (30) days of notification of the determination, the fifth day after 3
the date an independent review organization affirms the healthcare insurer's 4
determination to rescind the exemption; or 5
(3) Twelve (12) months after the effective date of the 6
exemption. 7
8
SECTION 4. Arkansas Code § 23 -99-1122(a), concerning the recission of 9
a prior authorization exemption under the Prior Authorization Transparency 10
Act, is amended to read as follows: 11
(a) A healthcare insurer may rescind an exemption from prior 12
authorization requirements of a healthcare provider under § 23 -99-1120 only 13
if: 14
(1) The healthcare insurer makes a determination that, on the 15
basis of a retrospective review of a random sample of claims selected by the 16
healthcare insurer during the most recent evaluation period described by § 17
23-99-1120(e) § 23-99-1120(b), less than ninety percent (90%) of the claims 18
for the particular healthcare service met the medical necessity criteria that 19
would have been used by the healthcare insurer when conducting prior 20
authorization review for the particular healthcare service during the 21
relevant evaluation period; 22
(2) The healthcare insurer complies with other applicable 23
requirements specified in this section, including without limitation: 24
(A) Notifying the healthcare provider no less than twenty-25
five (25) thirty (30) days before the proposed rescission is to take effect; 26
and 27
(B) Providing: 28
(i) An identification of the healthcare service that 29
an exemption is being rescinded, the date the notice is issued, and the 30
effective date of the rescission; 31
(ii) A plain-language explanation of how the 32
healthcare provider may appeal and seek an independent review of the 33
determination, the date the notice is issued, and the company's address and 34
contact information for returning the form by mail or email to request an 35
appeal; 36 As Engrossed: H2/5/25 H2/20/25 H3/13/25 HB1301
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(iii) A statement of the total number of payable 1
claims submitted by or in connection with the healthcare provider during the 2
most recent evaluation period that were eligible to be evaluated with respect 3
to the healthcare service subject to rescission, the number of claims 4
included in the random sample, and the sample information used to make the 5
determination, including without limitation: 6
(a) Identification of each claim included in 7
the random sample; 8
(b) The healthcare insurer's determination of 9
whether each claim met the healthcare insurer's screening criteria; and 10
(c) For any claim determined to not have met 11
the healthcare insurer's screening criteria: 12
(1) The principal reasons for the 13
determination that the claim did not meet the healthcare insurer's screening 14
criteria, including, if applicable, a statement that the determination was 15
based on a failure to submit specified medical records; 16
(2) The clinical basis for the 17
determination that the claim did not meet the healthcare insurer's screening 18
criteria; 19
(3) A description of the sources of the 20
screening criteria that were used as guidelines in making the determination; 21
and 22
(4) The professional specialty of the 23
healthcare provider who made the determination; 24
(iv) A space to be filled out by the healthcare 25
provider that includes: 26
(a) The name, address, contact information, 27
and identification number of the healthcare provider requesting an 28
independent review; 29
(b) An indication of whether or not the 30
healthcare provider is requesting that the entity performing the independent 31
review examine the same random sample or a different random sample of claims, 32
if available; and 33
(c) The date the appeal is being requested; 34
and 35
(v) An instruction to the healthcare provider to 36 As Engrossed: H2/5/25 H2/20/25 H3/13/25 HB1301
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return the form to the healthcare insurer before the date the rescission 1
becomes effective; and 2
(3) The healthcare provider performs five (5) or fewer of 3
a particular healthcare service in the most recent six -month evaluation 4
period under § 23-99-1120(e) § 23-99-1120(b). 5
6
SECTION 5. Arkansas Code § 23 -99-1122(c)(2), concerning the timeline a 7
healthcare insurer provides to a healthcare provider to provide medical 8
records under the Prior Authorization Transparency Act, is amended to read as 9
follows: 10
(2) A healthcare insurer shall provide a healthcare provider at 11
least thirty (30) sixty (60) days to provide the medical records requested 12
under subdivision (c)(1) of this section. 13
14
SECTION 6. Arkansas Code § 23 -99-1126(a), concerning the payments to a 15
healthcare provider who has an exemption under the Prior Authorization 16
Transparency Act, is amended to read as follows: 17
(a)(1) A healthcare insurer shall not deny or reduce payment to a 18
healthcare provider for a healthcare service for which the healthcare 19
provider has qualified for an exemption from prior authorization requirements 20
under § 23-99-1120, including a healthcare service performed or supervised by 21
another healthcare provider, if the healthcare provider who ordered the 22
healthcare service received a prior authorization exemption based on medical 23
necessity or appropriateness of care unless the healthcare provider: 24
(1)(A) Knowingly and materially misrepresented the 25
healthcare service in a request for payment submitted to the healthcare 26
insurer with the specific intent to deceive the healthcare insurer and obtain 27
an unlawful payment from the healthcare insurer; or 28
(2)(B) Substantially failed to perform the healthcare 29
service. 30
(2)(A) Subdivision (a)(1) of this section does not constitute a 31
basis for a healthcare insurer to: 32
(i) Request information from a healthcare provider; 33
or 34
(ii) Delay reimbursement in order to obtain 35
information. 36 As Engrossed: H2/5/25 H2/20/25 H3/13/25 HB1301
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(B) A request for information under subdivision 1
(a)(2)(A)(i) of this section shall comply with applicable laws and rules. 2
3
SECTION 7. Arkansas Code § 23 -99-1126(d), concerning the information 4
required in the notice to a healthcare provider under the Prior Authorization 5
Transparency Act, is amended to read as follows: 6
(d) Beginning on January 1, 2024, a A healthcare insurer shall provide 7
to a healthcare provider a notice that includes a: 8
(1) Statement that the healthcare provider has an exemption from 9
prior authorization requirements under § 23 -99-1120; 10
(2) List of the healthcare services and health benefit plans to 11
which the exemption applies; and 12
(3) Statement of the duration of the exemption. 13
14
SECTION 8. Arkansas Code § 23 -99-1127 is amended to read as follows: 15
23-99-1127. Applicability. 16
(a)(1) An organization or entity directly or indirectly providing a 17
plan or services to patients under the Medicaid Provider -Led Organized Care 18
Act, § 20-77-2701 et seq., or any other Medicaid -managed care program 19
operating in this state is exempt from §§ 23 -99-1120 — 23-99-1126 if the 20
program, without limiting the program's application to any other plan or 21
program, develops and conforms to a program to reduce or eliminate prior 22
authorizations for a healthcare provider on or before January 1, 2025 . 23
(2) The Arkansas Health and Opportunity for Me Program 24
established by the Arkansas Health and Opportunity for Me Act of 2021, § 23 -25
61-1001 et seq., or its successor program is exempt from §§ 23 -99-1120 — 23-26
99-1126, provided that the Arkansas Health and Opportunity for Me Program, 27
without limiting the Arkansas Health and Opportunity for Me Program's 28
application to any other plan or program, develops and conforms to a program 29
to reduce or eliminate prior authorizations for a healthcare provider on or 30
before January 1, 2025 . 31
(3) A qualified health plan that is a health benefit plan under 32
the Patient Protection and Affordable Care Act, Pub. L. No. 111 -148, and 33
purchased on the Arkansas Health Insurance Marketplace created under the 34
Arkansas Health Insurance Marketplace Act, § 23 -61-801 et seq., for an 35
individual up to four hundred percent (400%) of the federal poverty level, 36 As Engrossed: H2/5/25 H2/20/25 H3/13/25 HB1301
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operating in this state is exempt from §§ 23 -99-1120 — 23-99-1126 if the 1
qualified health plan, without limiting the program's application to any 2
other plan or program, develops and conforms to a program to reduce or 3
eliminate prior authorizations for a healthcare provider on or before January 4
1, 2025. 5
(b)(1)(A) The programs At least one (1) time every two (2) years, a 6
program under subsection (a) of this section to reduce or eliminate prior 7
authorization shall be: 8
(A)(i) Submitted to the State Insurance Department; 9
and 10
(B)(ii) Subject to approval by the Legislative 11
Council. 12
(B) A program under subsection (a) of this section shall 13
include: 14
(i) Data, statistics, and other appropriate 15
documentation demonstrating the effectiveness of the previously submitted 16
program in reducing or eliminating prior authorizations for a healthcare 17
provider; and 18
(ii) For a program that does not eliminate prior 19
authorizations for a healthcare provider, specific initiatives or elements of 20
the program that reduce existing prior authorizations for a healthcare 21
provider. 22
(C)(i) Upon submitting the program under subdivision 23
(b)(1) of this section, the submitting entity shall provide notice to each 24
healthcare provider that includes: 25
(a) The complete program submission; 26
(b) The deadline for a healthcare provider to 27
comment on the program submission; and 28
(c) Instructions on how a healthcare provider 29
may comment on the program. 30
(ii) A healthcare provider shall have at least 31
thirty (30) days to comment on a program submitted under subdivision (b)(1) 32
of this section. 33
(2) If a program is not submitted to the department and approved 34
by the Legislative Council on or before January 1, 2025 as required or does 35
not conform to the requirements of this section , the Medicaid-managed care 36 As Engrossed: H2/5/25 H2/20/25 H3/13/25 HB1301
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program operating in this state, the Arkansas Health and Opportunity for Me 1
Program established by the Arkansas Health and Opportunity for Me Act of 2
2021, § 23-61-1001 et seq., or its successor program, and qualified health 3
plans under the Patient Protection and Affordable Care Act, Pub. L. No. 111 -4
148, and purchased on the Arkansas Health Insurance Marketplace created under 5
the Arkansas Health Insurance Marketplace Act, § 23 -61-801 et seq., for an 6
individual up to four hundred percent (400%) of the federal poverty level, 7
operating in this state shall be subject to §§ 23 -99-1120 — 23-99-1126 and § 8
23-99-1128 as of January 1, 2025 . 9
(c) Any state or local governmental employee plan is exempt from §§ 10
23-99-1120 — 23-99-1126 and § 23-99-1128. 11
(d) A health benefit plan provided by a trust established under §§ 14 -12
54-101 and 25-20-104 to provide benefits, including accident and health 13
benefits, death benefits, dental benefits, and disability income benefits, is 14
exempt from §§ 23-99-1120 — 23-99-1126. 15
(e)(1) Prescription drugs, medicines, biological products, 16
pharmaceuticals, or pharmaceutical services are exempt as a healthcare 17
service for purposes of §§ 23 -99-1120 — 23-99-1126 until December 31, 2024 18
subject to the gold card program unless exempted from the gold card program 19
under § 23-99-1128(b). 20
(2)(A) As of January 1, 2025, the provisions of §§ 23 -99-1120 — 21
23-99-1126 shall apply to prescription drugs, medicines, biological products, 22
pharmaceuticals, or pharmaceutical services that have not been approved for 23
continuation of prior authorization under § 23 -99-1128. 24
(B) For the products in subdivision (e)(2)(A) of this 25
section that have not been approved for continuation of prior authorization, 26
for purposes of § 23 -99-1120, then: 27
(i) Provisions regarding time periods specified 28
during calendar year 2022 shall instead apply to the same months during 29
calendar year 2023; and 30
(ii) Provisions regarding time periods specified 31
during calendar year 2024 shall instead apply to the same months during 32
calendar year 2025. 33
(f)(1) Upon request, a healthcare insurer or a pharmacy benefits 34
manager shall send an eligibility file notification to a healthcare provider. 35
(2) An eligibility file notification under subdivision (f)(1) of 36 As Engrossed: H2/5/25 H2/20/25 H3/13/25 HB1301
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this section shall indicate whether a subscriber is enrolled in a: 1
(A) Health benefit plan that is: 2
(i) Self-insured under the Employee Retirement 3
Income Security Act of 1974, Pub. L. No. 93 -406; 4
(ii) A fully insured health benefit plan; or 5
(iii) A self-funded health benefit plan; 6
(B) Qualified health benefit plan that is a health benefit 7
plan under the Patient Protection and Affordable Care Act, Pub. L. No. 111 -8
148, and purchased on the Arkansas Health Insurance Marketplace created under 9
the Arkansas Health Insurance Marketplace Act, § 23 -61-801 et seq., for an 10
individual up to four hundred percent (400%) of the federal poverty level, 11
operating in this state; or 12
(C) Qualified health benefit plan that is a health benefit 13
plan under the Patient Protection and Affordable Care Act, Pub. L. No. 111 -14
148, and purchased as a health benefit plan under Arkansas Health Insurance 15
Marketplace created under the Arkansas Health Insurance Marketplace Act, § 16
23-61-801 et seq., for an individual over four hundred percent (400%) of the 17
federal poverty level. 18
19
SECTION 9. Arkansas Code § 23 -99-1128 is amended to read as follows: 20
23-99-1128. Prescription drugs, medicines, biological products, 21
pharmaceuticals, or pharmaceutical services. 22
(a)(1) Beginning on January 1, 2024, a healthcare insurer or pharmacy 23
benefits manager shall submit a written request to the Arkansas State Board 24
of Pharmacy for any prescription drug, medicine, biological product, 25
pharmaceutical, or pharmaceutical service to be reviewed for a continuation 26
of prior authorization by a specified health benefit plan whether or not a 27
healthcare provider has met the criteria for an exemption from prior 28
authorization under §§ 23 -99-1120 — 23-99-1126. 29
(2) The request under subdivision (a)(1) of this section shall 30
state the reason the request is being made for each prescription drug, 31
medicine, biological product, pharmaceutical, or pharmaceutical service for 32
the specified health benefit plan If a prescription drug, medicine, 33
biological product, pharmaceutical, or pharmaceutical service is not exempt 34
from the gold card program under subsection (b) of this section, then a 35
healthcare provider shall be reviewed by a healthcare insurer or pharmacy 36 As Engrossed: H2/5/25 H2/20/25 H3/13/25 HB1301
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benefits manager under the gold card program for the prescription drug, 1
medicine, biological product, pharmaceutical, or pharmaceutical service . 2
(b)(1) The Arkansas State Board of Pharmacy and the Arkansas State 3
Medical Board, jointly, may establish criteria and procedures to review 4
whether a request made under subdivision (a)(1) of this section should be 5
granted for the requesting party and specified health benefit plan For a 6
prescription drug, medicine, biological product, pharmaceutical, or 7
pharmaceutical service to be exempt from the gold card program, a healthcare 8
insurer or pharmacy benefits manager may submit a written request to the 9
Arkansas State Board of Pharmacy for approval. 10
(2) A request under subdivision (b)(1) of this section shall 11
state the reason the request is being made for each prescription drug, 12
medicine, biological product, pharmaceutical, or pharmaceutical service for 13
which exemption from the gold card program is requested. 14
(3) The Arkansas State Board of Pharmacy and the Arkansas State 15
Medical Board, jointly, shall establish criteria and procedures to review 16
whether a request for exemption from the gold card program made under 17
subdivision (b)(1) of this section should be granted. 18
(4) The criteria established under subdivision (b)(3) of this 19
section shall include criteria related to the cost and the safety of the 20
prescription drug, medicine, biological product, pharmaceutical, or 21
pharmaceutical service. 22
(5) Under the criteria established and procedures described 23
under subdivision (b)(3) of this section, the Arkansas State Board of 24
Pharmacy and the Arkansas State Medical Board, jointly, shall determine 25
whether to approve a request to exempt a prescription drug, medicine, 26
biological product, pharmaceutical, or pharmaceutical service from the gold 27
card program. 28
(6) The Arkansas State Board of Pharmacy shall promptly notify 29
the entity that made the request of the joint decision made by the Arkansas 30
State Board of Pharmacy and the Arkansas State Medical Board. 31
(7) The decision of the Arkansas State Board of Pharmacy and the 32
Arkansas State Medical Board, jointly, regarding each prescription drug, 33
medicine, biological product, pharmaceutical, or pharmaceutical service shall 34
apply to all healthcare insurers or pharmacy benefits managers. 35
(8) The Arkansas State Board of Pharmacy shall post on the 36 As Engrossed: H2/5/25 H2/20/25 H3/13/25 HB1301
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Arkansas State Board of Pharmacy's website a list of prescription drugs, 1
medicines, biological products, pharmaceuticals, or pharmaceutical services 2
that are exempt from the gold card program. 3
(9) An approval for exemption from the gold card program is 4
valid for two (2) years from the date of the notice provided under 5
subdivision (b)(6) of this section. 6
(c)(1) The Arkansas State Board of Pharmacy and the Arkansas State 7
Medical Board, jointly, may determine whether or not a prescription drug, 8
medicine, biological product, pharmaceutical, or pharmaceutical service may 9
be subject to prior authorization by a health benefit plan under the criteria 10
and procedures under subsection (b) of this section. 11
(2) The Arkansas State Board of Pharmacy shall promptly notify 12
the entity that made the request of the joint decision made by the Arkansas 13
State Board of Pharmacy and the Arkansas State Medical Board. 14
(d) The Arkansas State Board of Pharmacy shall make available to any 15
person who requests it, a list for any health benefit plan of prescription 16
drugs, medicines, biological products, pharmaceuticals, or pharmaceutical 17
services that require a prior authorization under this section. 18
19
SECTION 10. Arkansas Code § 23 -99-1129 is amended to read as follows: 20
23-99-1129. Appeals process for disallowance of prior authorization. 21
(a) If the Arkansas State Board of Pharmacy and the Arkansas State 22
Medical Board, jointly, disallow a prior authorization of a prescription 23
drug, medicine, biological product, pharmaceutical, or pharmaceutical service 24
requested under § 23 -99-1128, a healthcare insurer, pharmacy benefits 25
manager, or other interested party may file an appeal to the State Insurance 26
Department within ninety (90) days of the disallowance of the prior 27
authorization. 28
(b) The healthcare insurer, pharmacy benefits manager, or other 29
interested party shall provide a notice of seven (7) days to the Arkansas 30
State Board of Pharmacy and the Arkansas State Medical Board of the 31
healthcare insurer's, pharmacy benefits manager's, or other interested 32
party's intent to file an appeal. 33
(c) No later than the thirtieth day after the date a healthcare 34
insurer, pharmacy benefits manager, or other interested party files an appeal 35
under subsection (a) of this section, the Insurance Commissioner shall 36 As Engrossed: H2/5/25 H2/20/25 H3/13/25 HB1301
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appoint an independent review organization to review the appeal. 1
(c)(d) A healthcare insurer, pharmacy benefits manager, or other 2
interested party that files an appeal under subsection (a) of this section 3
shall pay for the independent review organization appointed under subsection 4
(b)(c) of this section to review the appeal. 5
(e)(1) If a healthcare insurer, pharmacy benefits manager, or other 6
interested party succeeds in its appeal and overturns the decision of the 7
Arkansas State Board of Pharmacy and the Arkansas State Medical Board, the 8
healthcare insurer, pharmacy benefits manager, or other interested party 9
shall be reimbursed for fifty percent (50%) of the cost remitted to the 10
independent review organization under subsection (d) of this section. 11
(2) The Arkansas State Board of Pharmacy and the Arkansas State 12
Medical Board shall each provide twenty -five percent (25%) of the total 13
reimbursement to the healthcare insurer, pharmacy benefits manager, or other 14
interested party under subdivision (e)(1) of this section. 15
(d)(f) A healthcare insurer, pharmacy benefits manager, or other 16
interested party is bound by the independent review organization's 17
determination of the appeal under this section. 18
/s/L. Johnson 19
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APPROVED: 4/10/25 22
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