Stricken language would be deleted from and underlined language would be added to present law.
Act 570 of the Regular Session
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State of Arkansas As Engrossed: H3/18/25 1
95th General Assembly A Bill 2
Regular Session, 2025 HOUSE BILL 1703 3
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By: Representative L. Johnson 5
By: Senator Irvin 6
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For An Act To Be Entitled 8
AN ACT TO PROVIDE A DRUG REIMBURSEMENT PROCESS FOR 9
CERTAIN HEALTHCARE PROVIDERS; AND FOR OTHER PURPOSES. 10
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Subtitle 13
TO PROVIDE A DRUG REIMBURSEMENT PROCESS 14
FOR CERTAIN HEALTHCARE PROVIDERS. 15
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BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 17
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SECTION 1. Arkansas Code Title 23, Chapter 99, is amended to add an 19
additional subchapter to read as follows: 20
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Subchapter 19 — Drug Reimbursement Process 22
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23-99-1901. Definitions. 24
(a) As used in this subchapter: 25
(1) "Contracting entity” means a healthcare insurer or a 26
subcontractor, affiliate, or other entity that contracts directly or 27
indirectly with a healthcare provider for the delivery of healthcare services 28
to patients; 29
(2)(A) "Drug" means a substance prescribed, administered, or 30
employed by a healthcare provider that is used to prevent, diagnose, treat, 31
or relieve symptoms of a disease, injury, or abnormal condition. 32
(B) "Drug" includes a prescription drug, medicine, 33
biological product, pharmaceutical, radiopharmaceutical, or other medical 34
supply; 35
(3)(A) "Health benefit plan" means a plan, policy, contract, 36 As Engrossed: H3/18/25 HB1703
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certificate, agreement, or other evidence of coverage for healthcare services 1
offered or issued by a healthcare insurer in this state. 2
(B) "Health benefit plan" includes indemnity and managed 3
care plans. 4
(C) "Health benefit plan" does not include: 5
(i) A plan that provides only dental benefits or eye 6
and vision care benefits; 7
(ii) A disability income plan; 8
(iii) A credit insurance plan; 9
(iv) Insurance coverage issued as a supplement to 10
liability insurance; 11
(v) A medical payment under an automobile or 12
homeowners insurance plan; 13
(vi) A health benefit plan provided under Arkansas 14
Constitution, Article 5, § 32, the Workers' Compensation Law, § 11 -9-101 et 15
seq., or the Public Employee Workers' Compensation Act, § 21 -5-601 et seq.; 16
(vii) A plan that provides only indemnity for 17
hospital confinement; 18
(viii) An accident-only plan; 19
(ix) A specified disease plan; 20
(x) A long-term-care-only plan; or 21
(xi) Nonfederal governmental plans as defined in 29 22
U.S.C. § 1002(32), as it existed on January 1, 2025; 23
(4)(A) "Healthcare insurer" means an entity that is subject to 24
state insurance regulation and provides health insurance in this state. 25
(B) "Healthcare insurer" includes: 26
(i) An insurance company; 27
(ii) A health maintenance organization; or 28
(iii) A hospital and medical service corporation. 29
(C) "Healthcare insurer" does not include an entity that 30
provides only dental benefits or eye and vision care benefits; 31
(5) "Healthcare provider" means a person or entity that is 32
licensed, certified, or otherwise authorized by the laws of this state to 33
provide healthcare services; and 34
(6)(A) "Healthcare services" means services or goods provided 35
for the purpose of or incidental to the purpose of preventing, diagnosing, 36 As Engrossed: H3/18/25 HB1703
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treating, alleviating, relieving, curing, or healing human illness, disease, 1
condition, disability, or injury. 2
(B) "Healthcare services” includes services for the 3
diagnosis, prevention, treatment, or cure of a condition, illness, injury, or 4
disease. 5
(C) "Healthcare services" does not include a service 6
reimbursed through a pharmacy benefits manager licensed under the Arkansas 7
Pharmacy Benefits Manager Licensure Act, § 23 -92-501 et seq. 8
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23-99-1902. Drug reimbursement process. 10
(a)(1) A contracting entity shall provide a reasonable administrative 11
appeal procedure to allow a healthcare provider to challenge the 12
reimbursement for a specific drug as being below the healthcare provider’s 13
drug acquisition cost. 14
(2) The reasonable administrative appeal procedure under 15
subdivision (a)(1) of this section shall include: 16
(A) A dedicated telephone number, email address, and 17
website for the purpose of submitting an administrative appeal; 18
(B) The ability to submit an administrative appeal 19
directly to the healthcare insurer or health benefit plan; and 20
(C) The ability to file an administrative appeal no less 21
than sixty (60) business days following the adjudication of a claim. 22
(b) If a challenge is made under subsection (a) of this section, 23
within thirty (30) business days of receipt of the challenge, the contracting 24
entity shall: 25
(1) If the appeal is upheld: 26
(A) Make the change in the reimbursement rate to at least 27
one hundred ten percent (110%) of the healthcare provider’s drug acquisition 28
cost; 29
(B) Reprocess, or cause the healthcare insurer or health 30
benefit plan to reprocess, the claim in question at the reimbursement rate 31
established under subdivision (b)(1)(A) of this section; and 32
(C) Process, or cause the healthcare insurer or health 33
benefit plan to reprocess, any subsequent claim for the same drug, as 34
identified by the National Drug Code or Healthcare Common Procedure Coding 35
System, at the reimbursement rate established in subdivision (b)(1)(A) of 36 As Engrossed: H3/18/25 HB1703
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this section; or 1
(2) If the appeal is denied, provide the challenging healthcare 2
provider with the specific information about the basis for the denial, 3
including without limitation any additional information necessary to 4
establish the drug acquisition cost. 5
(c) If an appeal is upheld under subdivision (b)(1) of this section, the 6
rate established by the appeal shall remain in place: 7
(1) For an appeal initiated before the last month of a 8
contracting entity’s fiscal quarter, until the end of the fiscal quarter that 9
the appeal was initiated; and 10
(2) For an appeal initiated within the last month of a 11
contracting entity’s fiscal quarter, until the end of the fiscal quarter 12
following the quarter that the appeal was initiated. 13
(d)(1) A healthcare provider may provide a quarterly notice to a 14
contracting entity of all drugs with an acquisition cost below the contracted 15
reimbursement rate. 16
(2) If a contracting entity receives notice under subdivision 17
(d)(1) of this section, the contracting entity may change the reimbursement 18
rates to at least one hundred ten percent (110%) of the healthcare provider’s 19
drug acquisition cost without an appeal under this section. 20
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/s/L. Johnson 22
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APPROVED: 4/14/25 25
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