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 1620 3
4
By: Representative Gramlich 5
By: Senator K. Hammer 6
7
For An Act To Be Entitled 8
AN ACT TO AMEND THE LAW CONCERNING PHARMACY BENEFITS 9
MANAGERS; TO REGULATE PROCESSING AND PAYMENT OF 10
PHARMACY CLAIMS; TO CREATE THE PHARMACY AND 11
PHARMACIST TIMELY RECONCILIATION AND PAYMENT OF 12
PHARMACIST SERVICES ACT; TO AMEND THE ARKANSAS 13
PHARMACY AUDIT BILL OF RIGHTS; TO AMEND THE ARKANSAS 14
PHARMACY BENEFITS MANAGER LICENSURE ACT; AND FOR 15
OTHER PURPOSES. 16
17
18
Subtitle 19
TO AMEND THE LAW CONCERNING PHARMACY 20
BENEFITS MANAGERS; AND TO REGULATE 21
PROCESSING AND PAYMENT OF PHARMACY 22
CLAIMS. 23
24
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 25
26
SECTION 1. DO NOT CODIFY. Title. 27
This act shall be known and may be cited as the "Pharmacy and 28
Pharmacist Timely Reconciliation and Payment of Pharmacist Services Act". 29
30
SECTION 2. DO NOT CODIFY. Legislative findings. 31
The General Assembly finds that: 32
(1) It is beneficial to the State of Arkansas to support patient 33
access to prescription drugs and pharmacy services in a market that minimizes 34
difficulties caused by slow payments from pharmacy benefits managers to 35
improve patient care; 36 HB1620
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(2) Requiring prompt payment of coverage of prescription drugs 1
to an Arkansas-licensed pharmacy and pharmacist will ensure that these 2
pharmacies and pharmacists have stable and predictable cash flow from 3
contracted intermediaries, vendors, pharmacy benefits managers, and claims 4
processors hired by pharmaceutical manufacturers; and 5
(3) Prompt payment policies will improve the ability of an 6
Arkansas-licensed pharmacy to: 7
(A) Serve patients with better and more stable 8
prescription drug inventory for immediate patient -care needs; and 9
(B) Better respond to future national security threats and 10
natural disasters in the communities of Arkansas. 11
12
SECTION 3. Arkansas Code § 17 -92-1201, concerning the Arkansas 13
Pharmacy Audit Bill of Rights, is amended to add an additional subsection to 14
read as follows: 15
(i) This section does apply to the Arkansas Medicaid Program, 16
including a vendor or an entity that is hired or contracted by the Arkansas 17
Medicaid Program to conduct an audit of pharmacy claims processed under the 18
Arkansas Medicaid Program. 19
20
SECTION 4. Arkansas Code Title 17, Chapter 92, Subchapter 12, is 21
amended to add an additional section to read as follows: 22
17-92-1202. Definitions. 23
As used in this subchapter: 24
(1)(A) "Audit" means a financial audit, performance audit, 25
information technology audit, review, report of agreed -upon procedures, 26
compilation, examination, investigation, prepayment audit, or other report or 27
procedure regarding the practice of pharmacy, including without limitation an 28
audit of a pharmacist or pharmacy for pharmacist services. 29
(B) "Audit" includes a prescription validation request or 30
prescription validation review if: 31
(i) The prescription validation request or review 32
requires the pharmacist or pharmacy to submit additional information to the 33
pharmacy benefits manager after a claim has been processed successfully at 34
the point of sale; or 35
(ii) There is any attempted or required recoupment 36 HB1620
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of funds or denial of payment to the pharmacy or pharmacist after a 1
successful electronically billed or submitted claim based on a prescription 2
validation request or prescription validation review; 3
(2) "Prepayment audit" means an audit or review that occurs 4
shortly after the sale and dispensing of a drug to a patient and before the 5
reimbursement payment to the pharmacy, regardless of the label given to the 6
audit or review or the method used to communicate the prepayment audit to the 7
pharmacy; 8
(3) "Prescription validation request or review" means 9
information provided to a pharmacy or pharmacist to help educate, clarify, or 10
verify the accuracy and validity of prescription claim submissions; and 11
(4) "Randomly selected" means selected without method or 12
conscious decision. 13
14
SECTION 5. Arkansas Code § 23 -92-503(8), concerning the definition of 15
"pharmacy benefits manager" used under the Arkansas Pharmacy Benefits Manager 16
Licensure Act, is amended to read as follows: 17
(8)(A) "Pharmacy benefits manager" means a person, business, or 18
entity, including a wholly or partially owned or controlled subsidiary of a 19
pharmacy benefits manager, that provides claims processing services , pharmacy 20
benefits management services, or other prescription drug or device services, 21
or both any combination of the three (3) , for health benefit plans. 22
(B) "Pharmacy benefits manager" does not include any: 23
(i) Healthcare facility licensed in Arkansas; 24
(ii) Healthcare professional licensed in Arkansas; 25
(iii) Consultant who only provides advice as to the 26
selection or performance of a pharmacy benefits manager; or 27
(iv) Entity that provides claims processing services 28
or other prescription drug or device services for the fee -for-service 29
Arkansas Medicaid Program only in that capacity; 30
31
SECTION 6. Arkansas Code § 23 -92-503, concerning definitions used 32
under the Arkansas Pharmacy Benefits Manager Licensure Act, is amended to add 33
additional subdivisions to read as follows: 34
(16)(A) "Clean claim" means a pharmacy claim that does not have 35
a defect, including without limitation a lack of any required substantiating 36 HB1620
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documentation or particular circumstance requiring special treatment that may 1
prevent timely payment of the pharmacy claim. 2
(B) "Clean claim" includes an electronic pharmacy claim 3
that successfully processes in real time with an approval of drug, dosing, 4
prescriber, or patient eligibility upon an electronic adjudication of a 5
pharmacy claim with the displayed paid amount from the pharmacy benefits 6
manager and the patient copay. 7
(C) "Clean claim" does not include a successfully 8
adjudicated pharmacy claim that the pharmacy or pharmacist obtained by fraud 9
or a clerical error or misrepresentation of the pharmacy claim elements; 10
(17) "Date of the receipt of a claim" means a claim that is 11
considered to have been received: 12
(A) For an electronic claim, on the date on which the 13
claim is transferred; or 14
(B) For other manual or paper claim, on the fifth day 15
after the postmark date of the claim or the date specified in the time stamp 16
of the transmission, whichever is sooner; 17
(18) "Material alteration to a contract" means a change to a 18
contract or addendum to a contract that shall be made explicitly and shall 19
not be made by reference through a pharmacy provider manual; 20
(19)(A) "Pharmacy benefits management services" means the 21
management or administration of a plan or program that: 22
(i) Pays or reimburses for a price and covers the 23
cost of prescription drugs and medical devices; 24
(ii) Includes the processing and payment of claims 25
for prescription drugs and the adjudication of appeals or grievances related 26
to the prescription drug benefit; 27
(iii) Includes electronic or manual processing and 28
payment of claims through the adjudication of prescription drug manufacturer 29
coupons or prescription drug manufacturer discounts; or 30
(iv) Includes prescription discount card services, 31
processing, electronic adjudication, or payment of claims for prescription 32
drugs by a discount card or discount card processor in situations in which a 33
vendor that otherwise identifies itself as a discount card vendor has been 34
subcontracted or contracted directly or indirectly by another licensed 35
pharmacy benefits manager or healthcare payor. 36 HB1620
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(B) "Pharmacy benefits management services" does not 1
include a prescription discount card service if the: 2
(i) Entire amount is paid by the patient, and the 3
individual pharmacy has directly contracted with the prescription discount 4
card service for each individual pharmacy and not through a pharmacy services 5
administrative organization or a leased pharmacy benefits manager network; or 6
(ii) Entire amount is paid by the patient, and the 7
discount card is an in -house pharmacy discount card; 8
(20)(A) "Pharmacy provider manual" means a document provided by 9
a pharmacy benefits manager to a pharmacist or pharmacy that may provide 10
contracted pharmacy providers with information about regulations, 11
administrative procedures, billing instructions, information on how to meet 12
the pharmacist's or pharmacy's contractual obligations, contact information, 13
audit information, maximum allowable cost appeals, pricing appeals, and other 14
details about various networks managed by the pharmacy benefits manager. 15
(B) "Pharmacy provider manual" does not include a material 16
alteration to a contract that shall be made explicitly in a contract or 17
addendum; 18
(21)(A) "Prescription drug manufacturer" or "pharmaceutical 19
manufacturer" means a business or entity that makes, processes, or packages 20
prescription drugs, over -the-counter medications, or medical devices to sell 21
in a pharmacy or other healthcare facility. 22
(B) "Prescription drug manufacturer" or "pharmaceutical 23
manufacturer" includes an entity that manipulates, tests, or controls the 24
product or process; and 25
(22) "Prescription drug manufacturer coupon" or "pharmaceutical 26
manufacturer coupon" means a prescription drug discount that is: 27
(A) Utilized to reduce the cost of prescription 28
medications in a pharmacy at the point of sale in the form of copayment 29
reduction, discount, e -voucher, electronic voucher, or a card to help a 30
consumer reduce the out -of-pocket costs, including without limitation a 31
copayment and coinsurance, or otherwise lower the overall cost of 32
prescription drugs; and 33
(B) Sponsored or provided by a prescription drug 34
manufacturer or pharmaceutical manufacturer usually through a vendor or an 35
electronic claims processor. 36 HB1620
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1
SECTION 7. Arkansas Code Title 23, Chapter 92, Subchapter 5, is 2
amended to add additional sections to read as follows: 3
23-92-512. Pharmacy claims — Procedures. 4
(a) On and after January 1, 2026, a contract or a pharmacy provider 5
manual between a pharmacy benefits manager and a pharmacy or a pharmacist 6
shall be updated to indicate that the pharmacy benefits manager will issue, 7
mail, or otherwise transmit payment with respect to a clean claim submitted 8
by a pharmacy or a pharmacist: 9
(1) Seven (7) to fourteen (14) days after the date of the 10
receipt of a claim for an electronic claim; or 11
(2) Thirty (30) days after the date of the receipt of a claim 12
for any other paper or manually submitted claim. 13
(b)(1) A claim is a clean claim if the pharmacy benefits manager 14
receiving the claim does not provide notice to the submitting pharmacist or 15
pharmacy of any deficiency or error in the claim within: 16
(A) Ten (10) days after the date of the receipt of a claim 17
for an electronic claim; or 18
(B) Fifteen (15) days after the date of the receipt of a 19
claim for any other manual or paper claim. 20
(2)(A) If a pharmacy benefits manager determines that a 21
submitted claim is not a clean claim, the pharmacy benefits manager shall 22
notify the submitting pharmacy or pharmacist of the determination within the 23
period described under subdivision (b)(1) of this section. 24
(B) The notification required under subdivision (b)(2)(A) 25
of this section shall: 26
(i) Be submitted in writing or electronically by 27
email to the pharmacist or pharmacy to specify all defects, clerical errors, 28
or improprieties in the claim; and 29
(ii) List any additional information necessary for 30
the proper processing and payment of the claim. 31
(3)(A) After the additional information described in subdivision 32
(b)(2)(B)(ii) of this section is submitted by the network pharmacy, a claim 33
becomes a clean claim within ten (10) days if the pharmacy benefits manager 34
does not provide notice to the submitting network pharmacy of any remaining 35
defect or impropriety in the claim or of any new defect or impropriety in the 36 HB1620
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additional information submitted. 1
(B) A pharmacy benefits manager shall not provide notice 2
of a new deficiency or impropriety in the claim that could have been 3
identified by the pharmacy benefits manager in the original claim submission 4
under this subsection. 5
(c) A claim submitted to a pharmacy benefits manager that is not paid 6
by the pharmacy benefits manager within the time frame specified in 7
subdivision (a)(1) or subdivision (a)(2) of this section or is contested by 8
the pharmacy benefits manager within the time frame specified in subdivision 9
(b)(2) of this section shall be: 10
(1) Deemed to be a clean claim; and 11
(2) Paid by the pharmacy benefits manager according to 12
subsection (a) of this section. 13
(d) A payment of a clean claim under subdivision (c)(1) of this 14
section is considered to have been made on the date that: 15
(1) The payment is transferred, for an electronic claim; or 16
(2) The payment is submitted to the United States Postal Service 17
or common carrier for delivery, for any other claim. 18
(e)(1)(A) A pharmacy benefits manager shall pay a penalty of twelve 19
percent (12%) per month for a late payment of claims to the contracted 20
pharmacist or pharmacy. 21
(B) The penalty described under subdivision (e)(1)(A) of 22
this section begins the day after the required payment date and ends on the 23
date on which the proper payment for the clean claim is made. 24
(2)(A) As determined by the Insurance Commissioner, a pharmacy 25
benefits manager shall not be penalized or required to pay interest under 26
subdivision (e)(1) of this section in exigent circumstances that prevent the 27
timely processing of claims, including natural disasters and other unique and 28
unexpected events, unless it involves a cybersecurity breach or a data 29
security issue with the pharmacy benefits manager or healthcare payor. 30
(B) A cybersecurity breach or a data security issue 31
involving the pharmacy benefits manager or the healthcare payor that delays 32
payment to a pharmacist or a pharmacy is subject to interest payments. 33
(f)(1) A pharmacy benefits manager shall pay a clean claim submitted 34
electronically by an electronic transfer of funds if the submitting network 35
pharmacy so requests or has so requested previously that contract year. 36 HB1620
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(2) If the payment is made electronically, remittance may also 1
be made electronically by the pharmacy benefits manager. 2
(g)(1) This section does not prohibit or limit a claim or action that 3
an individual or organization has against a pharmacy, provider, or pharmacy 4
benefits manager that is not covered by the subject matter of this section. 5
(2) A pharmacy benefits manager shall not retaliate against an 6
individual, pharmacy, or provider for exercising a right of action under 7
subdivision (g)(1) of this section, as consistent with applicable federal or 8
state law. 9
10
23-92-513. Pharmaceutical manufacturers. 11
(a) A pharmaceutical manufacturer that utilizes a vendor, pharmacy 12
benefits manager, or electronic claims processor to process prescription drug 13
manufacturer coupons or pharmaceutical manufacturer coupons shall: 14
(1) Have an active wholesale distributor permit and be in good 15
standing with the Arkansas State Board of Pharmacy under § 20 -64-505; and 16
(2) Ensure that an intermediary, vendor, pharmacy benefits 17
manager, or a claims processor complies with timely payment of a pharmacy 18
claim as required under § 23 -92-512. 19
(b)(1) The board shall require a pharmaceutical manufacturer to pay 20
twelve percent (12%) interest per month directly to the affected pharmacy or 21
pharmacist if the pharmaceutical manufacturer's vendor or intermediary does 22
not resolve a complaint for a clean claim's being paid within: 23
(A) Fourteen (14) days after the date of the receipt of a 24
claim for an electronic claim ; or 25
(B) Thirty (30) days after the date of the receipt of a 26
claim for any other paper or manually submitted claim. 27
(2) The penalty described under subdivision (b)(1) of this 28
section begins the day after the required payment date and ends on the date 29
on which the proper payment for the clean claim is made. 30
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