Stricken language would be deleted from and underlined language would be added to present law.
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State of Arkansas 1
95th General Assembly A Bill 2
Regular Session, 2025 HOUSE BILL 1602 3
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By: Representative L. Johnson 5
By: Senator K. Hammer 6
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For An Act To Be Entitled 8
AN ACT TO AMEND THE ARKANSAS PHARMACY BENEFITS 9
MANAGER LICENSURE ACT; TO ESTABLISH FEES UNDER THE 10
ARKANSAS PHARMACY BENEFITS MANAGER LICENSURE ACT; TO 11
REQUIRE REPORTING OF CERTAIN INFORMATION BY A 12
PHARMACY BENEFITS MANAGER UNDER THE ARKANSAS PHARMACY 13
BENEFITS MANAGER LICENSURE ACT; AND FOR OTHER 14
PURPOSES. 15
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Subtitle 18
TO AMEND THE ARKANSAS PHARMACY BENEFITS 19
MANAGER LICENSURE ACT; TO ESTABLISH FEES 20
UNDER THE ARKANSAS PHARMACY BENEFITS 21
MANAGER LICENSURE ACT; AND TO REQUIRE 22
REPORTING OF CERTAIN INFORMATION BY A 23
PHARMACY BENEFITS MANAGER. 24
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BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 26
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SECTION 1. Arkansas Code § 23 -92-503, concerning definitions used 28
under the Arkansas Pharmacy Benefits Manager Licensure Act, is amended to add 29
additional subdivisions to read as follows: 30
(16)(A) "Clean pharmacy claim" means a pharmacy claim that does 31
not have a defect, including without limitation a lack of any required 32
substantiating documentation or particular circumstance requiring special 33
treatment that may prevent timely payment of the pharmacy claim. 34
(B) "Clean pharmacy claim" includes an electronic pharmacy 35
claim that successfully processes in real time with an approval of drug, 36 HB1602
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dosing, prescriber, or patient eligibility upon an electronic adjudication of 1
a pharmacy claim with the displayed paid amount from the pharmacy benefits 2
manager and the patient copay. 3
(C) "Clean pharmacy claim" does not include a successfully 4
adjudicated pharmacy claim that the pharmacy or pharmacist obtained by fraud 5
or a clerical error or misrepresentation of the pharmacy claim elements; 6
(17)(A) "Pharmacy claims bank identification number" means a 7
six-digit number or an eight -digit number from the National Council for 8
Prescription Drug Programs Processor ID Number bank identification number 9
that is utilized and shared by a pharmacy benefits manager to electronically 10
process a pharmacy claim. 11
(B) "Pharmacy claims bank identification number" may be 12
known as RXBIN or NCPDP Processor BIN; 13
(18)(A) "Pharmacy claims group number" means a unique set of 14
numbers and letters that are used by a pharmacy benefits manager to identify 15
a specific employer, plan sponsor, insurance provider, or plan type that a 16
patient is enrolled in to cover and reimburse a pharmacy or a pharmacist for 17
pharmacist services. 18
(B) "Pharmacy claims group number" may be known as an 19
RxGroup number or a prescription group number; 20
(19)(A) "Pharmacy claims processor control number" means a 21
secondary identifier that is alphanumerical and clarifies the pharmacy claim 22
to a specific network or plan type that a pharmacy benefits manager may use 23
in processing a pharmacy claim for pharmacist services. 24
(B) "Pharmacy claims processor control number" may be 25
known as PCN or RxPCN; and 26
(20) "Unique combination for pharmacy claims" means a pharmacy 27
claims bank identification number, pharmacy claims group number, pharmacy 28
claims processor control number, or any combination of a pharmacy claims bank 29
identification number, pharmacy claims group number, and pharmacy claims 30
processor control number that is used by a pharmacy benefits manager to 31
process a pharmacy claim. 32
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SECTION 2. Arkansas Code § 23 -92-504 is amended to read as follows: 34
23-92-504. License to do business — Application — Fees — Rules. 35
(a)(1) A person or organization shall not establish or operate as a 36 HB1602
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pharmacy benefits manager in Arkansas for health benefit plans without 1
obtaining a license from the Insurance Commissioner under this subchapter. 2
(2) The commissioner shall prescribe the application for a 3
license to operate in Arkansas as a pharmacy benefits manager and may charge 4
application fees and renewal fees as established by rule . 5
(b) The commissioner shall issue rules establishing the licensing, 6
fees, application, financial standards, penalties, compliance and enforcement 7
requirements, and reporting requirements of pharmacy benefits managers under 8
this subchapter. 9
(c)(1) An initial application fee for a license as a pharmacy benefits 10
manager under this subchapter is one thousand dollars ($1,000) per unique 11
combination for pharmacy claims. 12
(2)(A) A renewal application fee for a license as a pharmacy 13
benefits manager under this subchapter is one thousand dollars ($1,000) per 14
unique combination for pharmacy claims. 15
(B) A renewal application and renewal application fee is 16
required annually per unique combination for pharmacy claims. 17
18
SECTION 3. Arkansas Code § 23 -92-509(a)(2), concerning the rules under 19
the Arkansas Pharmacy Benefits Manager Licensure Act, is amended to read as 20
follows: 21
(2) Rules that the commissioner may adopt under this subchapter 22
include without limitation rules relating to: 23
(A) Licensing; 24
(B) Application fees; 25
(C) Financial solvency requirements; 26
(D)(C) Pharmacy benefits manager network adequacy; 27
(E)(D) Prohibited market conduct practices; 28
(F)(E) Data reporting requirements under § 4 -88-803; 29
(G)(F) Compliance and enforcement requirements under § 17 -30
92-507 concerning Maximum Allowable Cost Lists; 31
(H)(G) Rebates; 32
(I)(H) Compensation; and 33
(J)(I) Lists of health benefit plans administered by a 34
pharmacy benefits manager in this state. 35
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SECTION 4. Arkansas Code Title 23, Chapter 92, Subchapter 5, is 1
amended to add an additional section to read as follows: 2
23-92-512. Pharmacy claims — Pharmacy claims bank identification 3
number, pharmacy claims group number, and pharmacy claims processor control 4
number — Reporting. 5
(a) A pharmacy benefits manager may differentiate different health 6
benefit plans, networks, or benefit packages with the use of a unique number 7
or other form of identification. 8
(b) At the time of renewal of a pharmacy benefits manager license, a 9
pharmacy benefits manager shall report to the Insurance Commissioner: 10
(1) Each pharmacy claims bank identification number, pharmacy 11
claims group number, and pharmacy claims processor control number that is 12
used by the pharmacy benefits manager; 13
(2) Each unique combination for pharmacy claims; 14
(3) Each unique combination for pharmacy claims by the estimated 15
number of covered lives in each combination by: 16
(A) Less than five hundred (500); 17
(B) Five hundred (500) to five thousand (5,000); 18
(C) Five thousand (5,000) to twenty -five thousand 19
(25,000); 20
(D) Twenty-five thousand (25,000) to one hundred thousand 21
(100,000); and 22
(E) Greater than one hundred thousand (100,000); and 23
(4) Each unique combination for pharmacy claims by plan type and 24
network that apply to: 25
(A) An employer-sponsored plan; 26
(B) A fully-insured plan; 27
(C) A self-funded plan; 28
(D) A plan or program that is funded by a state 29
appropriation to furnish, cover the cost of, or otherwise provide for 30
pharmacist services; 31
(E) A plan or program that is funded by the United States 32
Government or covers a federal employee, including without limitation Tricare 33
and Medicare Part D; 34
(F) A plan that is provided to municipal or county 35
employees; 36 HB1602
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(G) A plan that is provided to the Division of Arkansas 1
State Police; 2
(H) A plan that is provided to an employee of a public 3
two-year or four-year institution of higher education, including a community 4
college or technical collect; 5
(I) A plan provided under the Medicaid provider -led 6
organized care system; 7
(J) A plan provided by the Arkansas Health and Opportunity 8
for Me Program established by the Arkansas Health and Opportunity for Me Act 9
of 2021, § 23-61-1001 et seq.; or 10
(K) Any other plan types identified by the commissioner by 11
rule. 12
(c)(1) A pharmacy claims bank identification number may: 13
(A) Identify a specific pharmacy benefits manager, a 14
specific employer, or a sponsor of a plan; 15
(B) Be connected to a nationwide pharmacy benefits manager 16
database used to transmit and electronically process a pharmacy claim for a 17
pharmacist or a pharmacy for pharmacist services; and 18
(C)(i) Be used if the pharmacy benefits manager does not 19
use or issue a pharmacy benefit card with a magnetic stripe. 20
(ii) A pharmacy benefits manager that uses or issues 21
a pharmacy benefit card with a magnetic stripe may use the current 22
recommended International Organization for Standardization and the 23
International Electrotechnical Commission issuer identifier number for 24
electronically processing a pharmacy claim. 25
(2) The pharmacy claims bank identification number may be a 26
mandatory routing number to be used in electronic pharmacy claims submitted 27
through the National Council for Prescription Drug Programs billing 28
standards. 29
(d)(1) A pharmacy claims group number may be used to process a 30
pharmacy claim in addition to a pharmacy claims bank identification number. 31
(2) A pharmacy claims group number is not required for 32
submission of a clean pharmacy claim unless the pharmacy benefits manager 33
requires the pharmacy claims group number in order to identify a network or 34
group of covered patients that require this information for submission of a 35
clean pharmacy claim. 36 HB1602
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(e)(1) A pharmacy claims processor control number may be used by a 1
pharmacy benefits manager with an identifier that is unique to the pharmacy 2
benefits manager's business needs. 3
(2) A pharmacy claims processor control number is not required 4
for submission of a clean pharmacy claim unless the pharmacy benefits manager 5
requires the pharmacy claims processor control number in order to identify a 6
network or group of covered patients that require this information for 7
submission of a clean pharmacy claim. 8
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