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Arkansas House Bill HB1620

Arkansas 2025 Regular Session

Arkansas House Bill HB1620 Compare Versions

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11 Stricken language would be deleted from and underlined language would be added to present law.
2-Act 350 of the Regular Session
32 *ANS255* 02/27/2025 7:38:24 AM ANS255
43 State of Arkansas 1
54 95th General Assembly A Bill 2
65 Regular Session, 2025 HOUSE BILL 1620 3
76 4
87 By: Representative Gramlich 5
98 By: Senator K. Hammer 6
109 7
1110 For An Act To Be Entitled 8
1211 AN ACT TO AMEND THE LAW CONCERNING PHARMACY BENEFITS 9
1312 MANAGERS; TO REGULATE PROCESSING AND PAYMENT OF 10
1413 PHARMACY CLAIMS; TO CREATE THE PHARMACY AND 11
1514 PHARMACIST TIMELY RECONCILIATION AND PAYMENT OF 12
1615 PHARMACIST SERVICES ACT; TO AMEND THE ARKANSAS 13
1716 PHARMACY AUDIT BILL OF RIGHTS; TO AMEND THE ARKANSAS 14
1817 PHARMACY BENEFITS MANAGER LICENSURE ACT; AND FOR 15
1918 OTHER PURPOSES. 16
2019 17
2120 18
2221 Subtitle 19
2322 TO AMEND THE LAW CONCERNING PHARMACY 20
2423 BENEFITS MANAGERS; AND TO REGULATE 21
2524 PROCESSING AND PAYMENT OF PHARMACY 22
2625 CLAIMS. 23
2726 24
2827 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 25
2928 26
3029 SECTION 1. DO NOT CODIFY. Title. 27
3130 This act shall be known and may be cited as the "Pharmacy and 28
3231 Pharmacist Timely Reconciliation and Payment of Pharmacist Services Act". 29
3332 30
3433 SECTION 2. DO NOT CODIFY. Legislative findings. 31
3534 The General Assembly finds that: 32
3635 (1) It is beneficial to the State of Arkansas to support patient 33
3736 access to prescription drugs and pharmacy services in a market that minimizes 34
3837 difficulties caused by slow payments from pharmacy benefits managers to 35
3938 improve patient care; 36 HB1620
4039
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4241 (2) Requiring prompt payment of coverage of prescription drugs 1
4342 to an Arkansas-licensed pharmacy and pharmacist will ensure that these 2
4443 pharmacies and pharmacists have stable and predictable cash flow from 3
4544 contracted intermediaries, vendors, pharmacy benefits managers, and claims 4
4645 processors hired by pharmaceutical manufacturers; and 5
4746 (3) Prompt payment policies will improve the ability of an 6
4847 Arkansas-licensed pharmacy to: 7
4948 (A) Serve patients with better and more stable 8
5049 prescription drug inventory for immediate patient -care needs; and 9
5150 (B) Better respond to future national security threats and 10
5251 natural disasters in the communities of Arkansas. 11
5352 12
5453 SECTION 3. Arkansas Code § 17 -92-1201, concerning the Arkansas 13
5554 Pharmacy Audit Bill of Rights, is amended to add an additional subsection to 14
5655 read as follows: 15
5756 (i) This section does apply to the Arkansas Medicaid Program, 16
5857 including a vendor or an entity that is hired or contracted by the Arkansas 17
5958 Medicaid Program to conduct an audit of pharmacy claims processed under the 18
6059 Arkansas Medicaid Program. 19
6160 20
6261 SECTION 4. Arkansas Code Title 17, Chapter 92, Subchapter 12, is 21
6362 amended to add an additional section to read as follows: 22
6463 17-92-1202. Definitions. 23
6564 As used in this subchapter: 24
6665 (1)(A) "Audit" means a financial audit, performance audit, 25
6766 information technology audit, review, report of agreed -upon procedures, 26
6867 compilation, examination, investigation, prepayment audit, or other report or 27
6968 procedure regarding the practice of pharmacy, including without limitation an 28
7069 audit of a pharmacist or pharmacy for pharmacist services. 29
7170 (B) "Audit" includes a prescription validation request or 30
7271 prescription validation review if: 31
7372 (i) The prescription validation request or review 32
7473 requires the pharmacist or pharmacy to submit additional information to the 33
7574 pharmacy benefits manager after a claim has been processed successfully at 34
7675 the point of sale; or 35
7776 (ii) There is any attempted or required recoupment 36 HB1620
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8079 of funds or denial of payment to the pharmacy or pharmacist after a 1
8180 successful electronically billed or submitted claim based on a prescription 2
8281 validation request or prescription validation review; 3
8382 (2) "Prepayment audit" means an audit or review that occurs 4
8483 shortly after the sale and dispensing of a drug to a patient and before the 5
8584 reimbursement payment to the pharmacy, regardless of the label given to the 6
8685 audit or review or the method used to communicate the prepayment audit to the 7
8786 pharmacy; 8
8887 (3) "Prescription validation request or review" means 9
8988 information provided to a pharmacy or pharmacist to help educate, clarify, or 10
9089 verify the accuracy and validity of prescription claim submissions; and 11
9190 (4) "Randomly selected" means selected without method or 12
9291 conscious decision. 13
9392 14
9493 SECTION 5. Arkansas Code § 23 -92-503(8), concerning the definition of 15
9594 "pharmacy benefits manager" used under the Arkansas Pharmacy Benefits Manager 16
9695 Licensure Act, is amended to read as follows: 17
9796 (8)(A) "Pharmacy benefits manager" means a person, business, or 18
9897 entity, including a wholly or partially owned or controlled subsidiary of a 19
9998 pharmacy benefits manager, that provides claims processing services , pharmacy 20
10099 benefits management services, or other prescription drug or device services, 21
101100 or both any combination of the three (3) , for health benefit plans. 22
102101 (B) "Pharmacy benefits manager" does not include any: 23
103102 (i) Healthcare facility licensed in Arkansas; 24
104103 (ii) Healthcare professional licensed in Arkansas; 25
105104 (iii) Consultant who only provides advice as to the 26
106105 selection or performance of a pharmacy benefits manager; or 27
107106 (iv) Entity that provides claims processing services 28
108107 or other prescription drug or device services for the fee -for-service 29
109108 Arkansas Medicaid Program only in that capacity; 30
110109 31
111110 SECTION 6. Arkansas Code § 23 -92-503, concerning definitions used 32
112111 under the Arkansas Pharmacy Benefits Manager Licensure Act, is amended to add 33
113112 additional subdivisions to read as follows: 34
114113 (16)(A) "Clean claim" means a pharmacy claim that does not have 35
115114 a defect, including without limitation a lack of any required substantiating 36 HB1620
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118117 documentation or particular circumstance requiring special treatment that may 1
119118 prevent timely payment of the pharmacy claim. 2
120119 (B) "Clean claim" includes an electronic pharmacy claim 3
121120 that successfully processes in real time with an approval of drug, dosing, 4
122121 prescriber, or patient eligibility upon an electronic adjudication of a 5
123122 pharmacy claim with the displayed paid amount from the pharmacy benefits 6
124123 manager and the patient copay. 7
125124 (C) "Clean claim" does not include a successfully 8
126125 adjudicated pharmacy claim that the pharmacy or pharmacist obtained by fraud 9
127126 or a clerical error or misrepresentation of the pharmacy claim elements; 10
128127 (17) "Date of the receipt of a claim" means a claim that is 11
129128 considered to have been received: 12
130129 (A) For an electronic claim, on the date on which the 13
131130 claim is transferred; or 14
132131 (B) For other manual or paper claim, on the fifth day 15
133132 after the postmark date of the claim or the date specified in the time stamp 16
134133 of the transmission, whichever is sooner; 17
135134 (18) "Material alteration to a contract" means a change to a 18
136135 contract or addendum to a contract that shall be made explicitly and shall 19
137136 not be made by reference through a pharmacy provider manual; 20
138137 (19)(A) "Pharmacy benefits management services" means the 21
139138 management or administration of a plan or program that: 22
140139 (i) Pays or reimburses for a price and covers the 23
141140 cost of prescription drugs and medical devices; 24
142141 (ii) Includes the processing and payment of claims 25
143142 for prescription drugs and the adjudication of appeals or grievances related 26
144143 to the prescription drug benefit; 27
145144 (iii) Includes electronic or manual processing and 28
146145 payment of claims through the adjudication of prescription drug manufacturer 29
147146 coupons or prescription drug manufacturer discounts; or 30
148147 (iv) Includes prescription discount card services, 31
149148 processing, electronic adjudication, or payment of claims for prescription 32
150149 drugs by a discount card or discount card processor in situations in which a 33
151150 vendor that otherwise identifies itself as a discount card vendor has been 34
152151 subcontracted or contracted directly or indirectly by another licensed 35
153152 pharmacy benefits manager or healthcare payor. 36 HB1620
154153
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156155 (B) "Pharmacy benefits management services" does not 1
157156 include a prescription discount card service if the: 2
158157 (i) Entire amount is paid by the patient, and the 3
159158 individual pharmacy has directly contracted with the prescription discount 4
160159 card service for each individual pharmacy and not through a pharmacy services 5
161160 administrative organization or a leased pharmacy benefits manager network; or 6
162161 (ii) Entire amount is paid by the patient, and the 7
163162 discount card is an in -house pharmacy discount card; 8
164163 (20)(A) "Pharmacy provider manual" means a document provided by 9
165164 a pharmacy benefits manager to a pharmacist or pharmacy that may provide 10
166165 contracted pharmacy providers with information about regulations, 11
167166 administrative procedures, billing instructions, information on how to meet 12
168167 the pharmacist's or pharmacy's contractual obligations, contact information, 13
169168 audit information, maximum allowable cost appeals, pricing appeals, and other 14
170169 details about various networks managed by the pharmacy benefits manager. 15
171170 (B) "Pharmacy provider manual" does not include a material 16
172171 alteration to a contract that shall be made explicitly in a contract or 17
173172 addendum; 18
174173 (21)(A) "Prescription drug manufacturer" or "pharmaceutical 19
175174 manufacturer" means a business or entity that makes, processes, or packages 20
176175 prescription drugs, over -the-counter medications, or medical devices to sell 21
177176 in a pharmacy or other healthcare facility. 22
178177 (B) "Prescription drug manufacturer" or "pharmaceutical 23
179178 manufacturer" includes an entity that manipulates, tests, or controls the 24
180179 product or process; and 25
181180 (22) "Prescription drug manufacturer coupon" or "pharmaceutical 26
182181 manufacturer coupon" means a prescription drug discount that is: 27
183182 (A) Utilized to reduce the cost of prescription 28
184183 medications in a pharmacy at the point of sale in the form of copayment 29
185184 reduction, discount, e -voucher, electronic voucher, or a card to help a 30
186185 consumer reduce the out -of-pocket costs, including without limitation a 31
187186 copayment and coinsurance, or otherwise lower the overall cost of 32
188187 prescription drugs; and 33
189188 (B) Sponsored or provided by a prescription drug 34
190189 manufacturer or pharmaceutical manufacturer usually through a vendor or an 35
191190 electronic claims processor. 36 HB1620
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194193 1
195194 SECTION 7. Arkansas Code Title 23, Chapter 92, Subchapter 5, is 2
196195 amended to add additional sections to read as follows: 3
197196 23-92-512. Pharmacy claims — Procedures. 4
198197 (a) On and after January 1, 2026, a contract or a pharmacy provider 5
199198 manual between a pharmacy benefits manager and a pharmacy or a pharmacist 6
200199 shall be updated to indicate that the pharmacy benefits manager will issue, 7
201200 mail, or otherwise transmit payment with respect to a clean claim submitted 8
202201 by a pharmacy or a pharmacist: 9
203202 (1) Seven (7) to fourteen (14) days after the date of the 10
204203 receipt of a claim for an electronic claim; or 11
205204 (2) Thirty (30) days after the date of the receipt of a claim 12
206205 for any other paper or manually submitted claim. 13
207206 (b)(1) A claim is a clean claim if the pharmacy benefits manager 14
208207 receiving the claim does not provide notice to the submitting pharmacist or 15
209208 pharmacy of any deficiency or error in the claim within: 16
210209 (A) Ten (10) days after the date of the receipt of a claim 17
211210 for an electronic claim; or 18
212211 (B) Fifteen (15) days after the date of the receipt of a 19
213212 claim for any other manual or paper claim. 20
214213 (2)(A) If a pharmacy benefits manager determines that a 21
215214 submitted claim is not a clean claim, the pharmacy benefits manager shall 22
216215 notify the submitting pharmacy or pharmacist of the determination within the 23
217216 period described under subdivision (b)(1) of this section. 24
218217 (B) The notification required under subdivision (b)(2)(A) 25
219218 of this section shall: 26
220219 (i) Be submitted in writing or electronically by 27
221220 email to the pharmacist or pharmacy to specify all defects, clerical errors, 28
222221 or improprieties in the claim; and 29
223222 (ii) List any additional information necessary for 30
224223 the proper processing and payment of the claim. 31
225224 (3)(A) After the additional information described in subdivision 32
226225 (b)(2)(B)(ii) of this section is submitted by the network pharmacy, a claim 33
227226 becomes a clean claim within ten (10) days if the pharmacy benefits manager 34
228227 does not provide notice to the submitting network pharmacy of any remaining 35
229228 defect or impropriety in the claim or of any new defect or impropriety in the 36 HB1620
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232231 additional information submitted. 1
233232 (B) A pharmacy benefits manager shall not provide notice 2
234233 of a new deficiency or impropriety in the claim that could have been 3
235234 identified by the pharmacy benefits manager in the original claim submission 4
236235 under this subsection. 5
237236 (c) A claim submitted to a pharmacy benefits manager that is not paid 6
238237 by the pharmacy benefits manager within the time frame specified in 7
239238 subdivision (a)(1) or subdivision (a)(2) of this section or is contested by 8
240239 the pharmacy benefits manager within the time frame specified in subdivision 9
241240 (b)(2) of this section shall be: 10
242241 (1) Deemed to be a clean claim; and 11
243242 (2) Paid by the pharmacy benefits manager according to 12
244243 subsection (a) of this section. 13
245244 (d) A payment of a clean claim under subdivision (c)(1) of this 14
246245 section is considered to have been made on the date that: 15
247246 (1) The payment is transferred, for an electronic claim; or 16
248247 (2) The payment is submitted to the United States Postal Service 17
249248 or common carrier for delivery, for any other claim. 18
250249 (e)(1)(A) A pharmacy benefits manager shall pay a penalty of twelve 19
251250 percent (12%) per month for a late payment of claims to the contracted 20
252251 pharmacist or pharmacy. 21
253252 (B) The penalty described under subdivision (e)(1)(A) of 22
254253 this section begins the day after the required payment date and ends on the 23
255254 date on which the proper payment for the clean claim is made. 24
256255 (2)(A) As determined by the Insurance Commissioner, a pharmacy 25
257256 benefits manager shall not be penalized or required to pay interest under 26
258257 subdivision (e)(1) of this section in exigent circumstances that prevent the 27
259258 timely processing of claims, including natural disasters and other unique and 28
260259 unexpected events, unless it involves a cybersecurity breach or a data 29
261260 security issue with the pharmacy benefits manager or healthcare payor. 30
262261 (B) A cybersecurity breach or a data security issue 31
263262 involving the pharmacy benefits manager or the healthcare payor that delays 32
264263 payment to a pharmacist or a pharmacy is subject to interest payments. 33
265264 (f)(1) A pharmacy benefits manager shall pay a clean claim submitted 34
266265 electronically by an electronic transfer of funds if the submitting network 35
267266 pharmacy so requests or has so requested previously that contract year. 36 HB1620
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270269 (2) If the payment is made electronically, remittance may also 1
271270 be made electronically by the pharmacy benefits manager. 2
272271 (g)(1) This section does not prohibit or limit a claim or action that 3
273272 an individual or organization has against a pharmacy, provider, or pharmacy 4
274273 benefits manager that is not covered by the subject matter of this section. 5
275274 (2) A pharmacy benefits manager shall not retaliate against an 6
276275 individual, pharmacy, or provider for exercising a right of action under 7
277276 subdivision (g)(1) of this section, as consistent with applicable federal or 8
278277 state law. 9
279278 10
280279 23-92-513. Pharmaceutical manufacturers. 11
281280 (a) A pharmaceutical manufacturer that utilizes a vendor, pharmacy 12
282281 benefits manager, or electronic claims processor to process prescription drug 13
283282 manufacturer coupons or pharmaceutical manufacturer coupons shall: 14
284283 (1) Have an active wholesale distributor permit and be in good 15
285284 standing with the Arkansas State Board of Pharmacy under § 20 -64-505; and 16
286285 (2) Ensure that an intermediary, vendor, pharmacy benefits 17
287286 manager, or a claims processor complies with timely payment of a pharmacy 18
288287 claim as required under § 23 -92-512. 19
289288 (b)(1) The board shall require a pharmaceutical manufacturer to pay 20
290289 twelve percent (12%) interest per month directly to the affected pharmacy or 21
291290 pharmacist if the pharmaceutical manufacturer's vendor or intermediary does 22
292291 not resolve a complaint for a clean claim's being paid within: 23
293292 (A) Fourteen (14) days after the date of the receipt of a 24
294293 claim for an electronic claim ; or 25
295294 (B) Thirty (30) days after the date of the receipt of a 26
296295 claim for any other paper or manually submitted claim. 27
297296 (2) The penalty described under subdivision (b)(1) of this 28
298297 section begins the day after the required payment date and ends on the date 29
299298 on which the proper payment for the clean claim is made. 30
300299 31
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302-APPROVED: 3/20/25 33
301+ 33
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