Stricken language would be deleted from and underlined language would be added to present law.
Act 633 of the Regular Session
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State of Arkansas As Engrossed: H3/13/25 S4/7/25 1
95th General Assembly A Bill 2
Regular Session, 2025 HOUSE BILL 1602 3
4
By: Representative L. Johnson 5
By: Senator K. Hammer 6
7
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
16
17
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
25
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 26
27
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 As Engrossed: H3/13/25 S4/7/25 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
33
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 As Engrossed: H3/13/25 S4/7/25 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 is twenty thousand dollars ($20,000) per pharmacy benefits manager 11
licensed under this subchapter. 12
(2)(A) A renewal application fee for a license as a pharmacy 13
benefits manager is twenty thousand dollars ($20,000) per pharmacy benefits 14
manager licensed under this subchapter. 15
(B) A renewal application and a renewal application fee 16
are required annually. 17
(C) The commissioner may reduce the initial application 18
fee under subdivision (c)(1) of this section or renewal application fee under 19
subdivision (c)(2) of this section for a pharmacy benefits manager if the 20
initial application fee or renewal application fee would constitute a 21
financial hardship that would prevent a pharmacy benefits manager from doing 22
business in this state or competing in the marketplace considering the 23
limited number of Arkansas patients impacted or the limited type of pharmacy 24
benefits manager services offered . 25
26
SECTION 3. Arkansas Code § 23 -92-509(a)(2), concerning the rules under 27
the Arkansas Pharmacy Benefits Manager Licensure Act, is amended to read as 28
follows: 29
(2) Rules that the commissioner may adopt under this subchapter 30
include without limitation rules relating to: 31
(A) Licensing; 32
(B) Application fees; 33
(C) Financial solvency requirements; 34
(D)(C) Pharmacy benefits manager network adequacy; 35
(E)(D) Prohibited market conduct practices; 36 As Engrossed: H3/13/25 S4/7/25 HB1602
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(F)(E) Data reporting requirements under § 4 -88-803; 1
(G)(F) Compliance and enforcement requirements under § 17 -2
92-507 concerning Maximum Allowable Cost Lists; 3
(H)(G) Rebates; 4
(I)(H) Compensation; and 5
(J)(I) Lists of health benefit plans administered by a 6
pharmacy benefits manager in this state. 7
8
SECTION 4. Arkansas Code Title 23, Chapter 92, Subchapter 5, is 9
amended to add an additional section to read as follows: 10
23-92-512. Pharmacy claims — Pharmacy claims bank identification 11
number, pharmacy claims group number, and pharmacy claims processor control 12
number — Reporting. 13
(a) A pharmacy benefits manager may differentiate different health 14
benefit plans, networks, or benefit packages with the use of a unique number 15
or other form of identification. 16
(b) At the time of renewal of a pharmacy benefits manager license, a 17
pharmacy benefits manager shall report to the Insurance Commissioner: 18
(1) Each pharmacy claims bank identification number, pharmacy 19
claims group number, and pharmacy claims processor control number that is 20
used by the pharmacy benefits manager; 21
(2) Each unique combination for pharmacy claims; 22
(3) Each unique combination for pharmacy claims by the estimated 23
number of covered lives in each combination by: 24
(A) Less than five hundred (500); 25
(B) Five hundred (500) to five thousand (5,000); 26
(C) Five thousand (5,000) to twenty -five thousand 27
(25,000); 28
(D) Twenty-five thousand (25,000) to one hundred thousand 29
(100,000); and 30
(E) Greater than one hundred thousand (100,000); and 31
(4) Each unique combination for pharmacy claims by plan type and 32
network that apply to: 33
(A) An employer-sponsored plan; 34
(B) A fully-insured plan; 35
(C) A self-funded plan; 36 As Engrossed: H3/13/25 S4/7/25 HB1602
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(D) A plan or program that is funded by a state 1
appropriation to furnish, cover the cost of, or otherwise provide for 2
pharmacist services; 3
(E) A plan or program that is funded by the United States 4
Government or covers a federal employee, including without limitation Tricare 5
and Medicare Part D; 6
(F) A plan that is provided to municipal or county 7
employees; 8
(G) A plan that is provided to the Division of Arkansas 9
State Police; 10
(H) A plan that is provided to an employee of a public 11
two-year or four-year institution of higher education, including a community 12
college or technical collect; 13
(I) A plan provided under the Medicaid provider -led 14
organized care system; 15
(J) A plan provided by the Arkansas Health and Opportunity 16
for Me Program established by the Arkansas Health and Opportunity for Me Act 17
of 2021, § 23-61-1001 et seq.; or 18
(K) Any other plan types identified by the commissioner by 19
rule. 20
(c)(1) A pharmacy claims bank identification number may: 21
(A) Identify a specific pharmacy benefits manager, a 22
specific employer, or a sponsor of a plan; 23
(B) Be connected to a nationwide pharmacy benefits manager 24
database used to transmit and electronically process a pharmacy claim for a 25
pharmacist or a pharmacy for pharmacist services; and 26
(C)(i) Be used if the pharmacy benefits manager does not 27
use or issue a pharmacy benefit card with a magnetic stripe. 28
(ii) A pharmacy benefits manager that uses or issues 29
a pharmacy benefit card with a magnetic stripe may use the current 30
recommended International Organization for Standardization and the 31
International Electrotechnical Commission issuer identifier number for 32
electronically processing a pharmacy claim. 33
(2) The pharmacy claims bank identification number may be a 34
mandatory routing number to be used in electronic pharmacy claims submitted 35
through the National Council for Prescription Drug Programs billing 36 As Engrossed: H3/13/25 S4/7/25 HB1602
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standards. 1
(d)(1) A pharmacy claims group number may be used to process a 2
pharmacy claim in addition to a pharmacy claims bank identification number. 3
(2) A pharmacy claims group number is not required for 4
submission of a clean pharmacy claim unless the pharmacy benefits manager 5
requires the pharmacy claims group number in order to identify a network or 6
group of covered patients that require this information for submission of a 7
clean pharmacy claim. 8
(e)(1) A pharmacy claims processor control number may be used by a 9
pharmacy benefits manager with an identifier that is unique to the pharmacy 10
benefits manager's business needs. 11
(2) A pharmacy claims processor control number is not required 12
for submission of a clean pharmacy claim unless the pharmacy benefits manager 13
requires the pharmacy claims processor control number in order to identify a 14
network or group of covered patients that require this information for 15
submission of a clean pharmacy claim. 16
(f)(1) Except as provided in subdivision (f)(2) of this section, the 17
information or data acquired during an examination under this section is: 18
(A) Considered nonproprietary and confidential under § 23 -19
61-107(a)(4) and § 23-61-207; and 20
(B) Not subject to the Freedom of Information Act of 1967, 21
§ 25-19-101 et seq. 22
(2) Information and data reported under this section shall not 23
be subject to subdivision (f)(1) of this section if the information and data 24
is available or shared by the commissioner: 25
(A) In a password-protected online database; or 26
(B) On request of: 27
(i) An Arkansas-licensed pharmacist or Arkansas -28
licensed pharmacy; or 29
(ii) The contracted pharmacy services administrative 30
organization of the Arkansas -licensed pharmacist or Arkansas -licensed 31
pharmacy. 32
33
/s/L. Johnson 34
APPROVED: 4/16/25 35
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