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 SENATE BILL 104 3
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By: Senator C. Penzo 5
By: Representative Lundstrum 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 PROTECT PATIENTS' RIGHTS 10
AND ACCESS TO MEDICATIONS; TO DECLARE AN EMERGENCY; 11
AND FOR OTHER PURPOSES. 12
13
14
Subtitle 15
TO AMEND THE ARKANSAS PHARMACY BENEFITS 16
MANAGER LICENSURE ACT; TO PROTECT 17
PATIENTS' RIGHTS AND ACCESS TO 18
MEDICATIONS; AND TO DECLARE AN 19
EMERGENCY. 20
21
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 22
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SECTION 1. DO NOT CODIFY. Legislative intent. 24
It is the intent of the General Assembly that this act shall regulate 25
the business practices of healthcare payors and pharmacy benefits managers: 26
(1) To ensure adequate access to pharmacy services as intended 27
and designed by underlying health benefit plans; 28
(2) To protect patients from unfair and deceptive trade 29
practices within the state; and 30
(3) To ensure pharmacy benefits management companies do not 31
interfere with a patient's rights under the patient's underlying health 32
benefit plan and always consider each patient's unique conditions and 33
limitations when enforcing any access prerequisites or conditions. 34
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SECTION 2. Arkansas Code § 23 -92-503, concerning the definitions used 36 SB104
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in the Arkansas Pharmacy Benefits Manager Licensure Act, is amended to add 1
additional subdivisions to read as follows: 2
(16) "Affiliate" means an entity that controls, is controlled 3
by, or is under common control with another entity, including an entity in 4
which control is established through one (1) or more intermediary entities, 5
such that the common controlling interest may be two (2) or more levels 6
removed from the specified entity; 7
(17)(A) "Carve-out network" means a subset of a pharmacy 8
benefits manager's network that: 9
(i) Is created by the pharmacy benefits manager; and 10
(ii) Limits access to a certain pharmacy or 11
pharmacist for a specific drug or category of drugs. 12
(B) "Carve-out network" includes any network that 13
restricts enrollee access to in -person pharmacy services within this state by 14
offering only limited methods of obtaining a prescription drug, including 15
mail-order only options, while presenting the appearance of a full network of 16
available pharmacies; 17
(18) "Enrollee" means an individual who is entitled to receive 18
healthcare services under the terms of a health benefit plan; 19
(19)(A) "Ghost network" means a pharmacy benefits manager 20
network that includes a pharmacy or pharmacist as a participating provider 21
when that participating provider is: 22
(i) Not accepting new patients; 23
(ii) No longer in practice; or 24
(iii) Otherwise unavailable to or restricted from 25
providing services to enrollees in this state. 26
(B) "Ghost network" includes a pharmacy network in which a 27
significant number of listed participating providers are not accessible to 28
enrollees within a reasonable time frame or geographic distance; 29
(20) "Healthcare payor affiliate" means a pharmacy or pharmacist 30
that directly or indirectly, through one (1) or more intermediaries, owns or 31
controls, is owned or controlled by, or is under common ownership or control 32
with a healthcare payor; and 33
(21)(A) "Self-administered prescription drug" means a 34
pharmaceutical that when prescribed does not require assistance by a third 35
party to administer and can be dispensed by a pharmacy or pharmacist to an 36 SB104
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enrollee for self-administration under federal and state laws and 1
regulations. 2
(B) "Self-administered prescription drug" does not include 3
over-the-counter medications that do not require a prescription. 4
5
SECTION 3. Arkansas Code § 23 -92-506(b), concerning prohibited 6
practices under the Arkansas Pharmacy Benefits Manager Licensure Act, is 7
amended to add an additional subdivision to read as follows: 8
(9) Unless reviewed and approved by the commissioner in 9
coordination with the board, require pharmacy accreditation standards or 10
certification requirements inconsistent with, more stringent than, or in 11
addition to requirements of the board. 12
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SECTION 4. Arkansas Code Title 23, Chapter 92, Subchapter 5, is 14
amended to add additional sections to read as follows: 15
23-92-512. Unfair and deceptive trade practices. 16
(a)(1) A healthcare payor, healthcare payor affiliate, pharmacy 17
benefits manager, or pharmacy benefits manager affiliate shall not engage in 18
unfair or deceptive trade practices in the administration of pharmacy 19
benefits. 20
(2) Unfair or deceptive trade practices under subdivision (a)(1) 21
of this section include without limitation: 22
(A) Requiring an enrollee to utilize a particular 23
healthcare payor affiliate or pharmacy benefits manager affiliate; 24
(B) Requiring a pharmacy or pharmacist to forward or 25
retransmit a prescription to a specific healthcare payor affiliate or 26
pharmacy benefits manager affiliate unless the receiving healthcare payor 27
affiliate or pharmacy benefits manager affiliate can provide verifiable 28
documentation of the enrollee's consent to use that specific pharmacy; 29
(C) Implementing a policy or protocol that unreasonably 30
restricts an enrollee's choice of pharmacy within the pharmacy benefits 31
manager network, if: 32
(i)(a) The pharmacy meets the pharmacy benefits 33
manager network's relevant and reasonable terms of participation 34
requirements. 35
(b) A disagreement or concern regarding 36 SB104
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whether relevant and reasonable terms of participation requirements are 1
relevant and reasonable shall be determined by the Insurance Commissioner; 2
and 3
(ii) The pharmacy has existing approval to dispense 4
one (1) or more self -administered prescription drugs in the pharmacy benefits 5
manager network or one (1) or more networks for the underlying health benefit 6
plan; 7
(D)(i) Providing an incentive or imposing a penalty that 8
effectively coerces or pressures an enrollee to use a particular healthcare 9
payor affiliate or pharmacy benefits manager affiliate. 10
(ii) Adjustments to an enrollee's cost -sharing 11
responsibilities, including copayments, coinsurance, or deductibles, that are 12
part of the health benefit plan's design are not considered incentives or 13
penalties under subdivision (a)(2)(D)(i) of this section; 14
(E) Failing to disclose to an enrollee the options 15
available for obtaining prescription drugs within the pharmacy benefits 16
manager network; 17
(F) Disclosing, sharing, or otherwise making available 18
enrollee information or enrollee -identifiable prescription information 19
submitted by a pharmacist or pharmacy to a healthcare payor affiliate or 20
pharmacy benefits manager affiliate without the written consent of the 21
enrollee; 22
(G) Using or disclosing enrollee information or enrollee -23
identifiable prescription information for marketing or solicitation purposes 24
without the written consent of the enrollee; and 25
(H)(i) Engaging in any conduct that unlawfully restricts, 26
limits, or interferes with an enrollee's right to choose a pharmacy or 27
pharmacist, including without limitation actions that violate federal law or 28
state law or improperly steer enrollees to a specific pharmacy or pharmacist. 29
(ii) The prohibition under subdivision (a)(2)(H)(i) 30
of this section does not apply to a change in patient cost -sharing 31
obligations, including copayments, coinsurance, or deductibles, that are 32
permitted under applicable law. 33
(b)(1) A healthcare payor, healthcare payor affiliate, pharmacy 34
benefits manager, or pharmacy benefits manager affiliate shall not impose 35
restrictive terms or conditions that limit an enrollee's or an enrollee’s 36 SB104
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assigned representative’s rights to seek an exception to or to appeal a 1
coverage decision or restriction with his or her health benefit plan. 2
(2) A healthcare payor, healthcare payor affiliate, pharmacy 3
benefits manager, or pharmacy benefits manager affiliate shall ensure that: 4
(A) The processes for seeking an exception and filing an 5
appeal are clearly communicated to patients in a publicly accessible manner 6
on its website; 7
(B) The information necessary to utilize the processes 8
under subdivision (b)(2)(A) of this section is presented in a manner that is 9
understandable and not hidden or obscured; and 10
(C) An enrollee is not hindered or obstructed from 11
exercising the rights granted to the enrollee under the enrollee's health 12
benefit plan. 13
(c)(1) A healthcare payor shall not prohibit, restrict, or impede an 14
enrollee’s or an enrollee’s authorized representative’s ability to: 15
(A) Discuss the enrollee's health benefit plan, including 16
prescription drug benefits, with the healthcare payor or its authorized 17
representatives; 18
(B) Obtain necessary exceptions, approvals, 19
authorizations, or related information to access the enrollee's benefits; or 20
(C) Appeal decisions regarding the enrollee's benefits 21
coverage decisions as provided under the terms of the enrollee's health 22
benefit plan. 23
(2) The healthcare payor shall ensure that an enrollee has 24
reasonable access to the discussions, approvals, and appeals processes 25
regardless of the pharmacy benefits manager, affiliate, or third -party 26
administrator selected to administer prescription benefits. 27
(3) It is an unfair and deceptive trade practice for a 28
healthcare payor to delegate responsibilities in a manner that obstructs, 29
hinders, or prevents an enrollee from exercising the enrollee's rights under 30
his or her health benefit plan. 31
(d)(1) A pharmacy benefits manager and pharmacy benefits manager 32
affiliate shall adhere to all applicable federal and state privacy laws when 33
communicating with an enrollee. 34
(2) A pharmacy benefits manager and pharmacy benefits manager 35
affiliate shall not use enrollee information for marketing purposes without 36 SB104
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the written consent of the enrollee. 1
(e) A pharmacy benefits manager and pharmacy benefits manager 2
affiliate shall comply with the timely processing of complaints and appeals 3
as established by rule of the commissioner. 4
(f)(1) The commissioner may promulgate rules necessary to implement, 5
administer, and enforce this section. 6
(2) Rules that the commissioner may adopt under this section 7
include without limitation rules relating to implementing a penalty structure 8
for a healthcare payor, healthcare payor affiliate, pharmacy benefits 9
manager, or pharmacy benefits manager affiliate that fails to comply with 10
this section that is based on the number of Arkansas residents serviced by 11
the healthcare payor, healthcare payor affiliate, pharmacy benefits manager, 12
or pharmacy benefits manager affiliate. 13
(g)(1) A violation of this subchapter is an unfair and deceptive act 14
or practice as defined by the Deceptive Trade Practices Act, § 4 -88-101 et 15
seq. 16
(2) All remedies, penalties, and authority granted to the 17
Attorney General under the Deceptive Trade Practices Act, § 4 -88-101 et seq., 18
shall be available to the Attorney General for the enforcement of this 19
subchapter. 20
21
23-92-513. Prohibition of ghost networks. 22
(a) A pharmacy benefits manager shall not create, utilize, or maintain 23
a ghost network within this state. 24
(b) A healthcare payor or pharmacy benefits manager shall not create, 25
utilize, or maintain a carve -out network within this state by: 26
(1) Limiting enrollee access to specific pharmacies or 27
pharmacists for self -administered prescription drugs when an enrollee is 28
directed to use a healthcare payor affiliate, pharmacy benefits manager 29
affiliate, or other limited option while the pharmacy benefits manager 30
network appears to offer a full range of pharmacist services; 31
(2) Failing to provide adequate access to in -person pharmacy 32
services within this state for all covered self -administered prescription 33
drugs; or 34
(3) Representing that a broad network of pharmacies or 35
pharmacists is available if, in practice, access to certain self -administered 36 SB104
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prescription drugs is restricted to a carve -out network that lacks sufficient 1
in-state providers accessible to an enrollee. 2
(c) A healthcare payor or pharmacy benefits manager shall ensure that 3
its pharmacy benefits manager network of participating pharmacists and 4
pharmacies: 5
(1) Accurately reflects the availability of pharmacists and 6
pharmacies actively accepting new patients; 7
(2) Provides an enrollee with reasonable access to pharmacist 8
services within this state, including options for in -person consultations and 9
medication pickup from a licensed pharmacist or pharmacy in this state; 10
(3) Is not solely serviced by a mail -order pharmacy; and 11
(4) Is not solely serviced by a pharmacy benefits manager 12
affiliate or healthcare payor affiliate. 13
(d) A healthcare payor or pharmacy benefits manager shall: 14
(1) Regularly verify and update its pharmacy benefits manager 15
network directory to reflect the current availability of participating 16
pharmacists and pharmacies; 17
(2) Remove a pharmacist or pharmacy from its pharmacy benefits 18
manager network directory if that pharmacist or pharmacy is: 19
(A) Not accepting new patients; 20
(B) No longer in practice; or 21
(C) Otherwise unavailable to provide services; and 22
(3) Provide accurate and accessible information to an enrollee 23
regarding participating pharmacists and pharmacies within the pharmacy 24
benefits manager network in a publicly accessible manner on its website. 25
(e)(1) The Insurance Commissioner may promulgate rules necessary to 26
implement, administer, and enforce this section. 27
(2) Rules that the commissioner may adopt under this section 28
include without limitation rules relating to: 29
(A) Requiring a healthcare payor and pharmacy benefits 30
manager to submit periodic reports on pharmacy benefits manager network 31
adequacy and accessibility; 32
(B) Investigating a complaint regarding a ghost network 33
and taking appropriate enforcement action; and 34
(C) Implementing a penalty structure for a healthcare 35
payor or pharmacy benefits manager that fails to comply with this section 36 SB104
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that: 1
(i) Is based on the number of Arkansas residents 2
serviced by the healthcare payor or pharmacy benefits manager; and 3
(ii) Does not exceed one hundred thousand dollars 4
($100,000) per violation. 5
6
23-92-514. Patient accommodation and nonrestriction clause. 7
(a) A healthcare payor or pharmacy benefits manager shall not enforce 8
the use of a particular healthcare payor affiliate or pharmacy benefits 9
manager affiliate or otherwise restrict an enrollee's choice of pharmacist or 10
pharmacy without considering the enrollee's individual limitations, including 11
without limitation: 12
(1) Medical limitations, including chronic illnesses, temporary 13
or permanent disabilities, or conditions requiring specialized care or that 14
impair cognitive or motor functions; 15
(2) Complex therapies, when the self -administered prescription 16
drug is one (1) of multiple pharmaceuticals provided to an enrollee receiving 17
treatment and mailing the individual pharmaceutical has the potential to 18
interfere with the appropriate and timely administration requirements; 19
(3) Physical limitations, including mobility impairments or 20
inability to retrieve mail or other deliveries without assistance or risk for 21
physical harm to self while retrieving mail or other deliveries; 22
(4) Socioeconomic limitations, including financial hardships, 23
lack of reliable transportation, lack of a caregiver, or other socioeconomic 24
barriers that may prohibit an enrollee from being present during delivery or 25
prohibit an enrollee from accessing the delivery location; 26
(5) Housing limitations, including homelessness, medical 27
confinement, incarceration, unstable housing situations, residences without 28
secure mail delivery options, or residences with shared mail facilities; 29
(6) Chain of custody, when a dispensing pharmacy cannot 30
guarantee that the recipient of the self -administered prescription drug will 31
be present according to federal and state laws and regulations; 32
(7) Prescribing provider order contradictions, when the 33
dispensing pharmacy is unable to guarantee that the prescribing provider's 34
orders will be followed if the self -administered prescription drug is 35
delivered, including situations in which the prescribing provider requires 36 SB104
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administration under direct supervision of a medical professional for a 1
customarily self-administered prescription drug; 2
(8) Medication storage and efficacy concerns, when the 3
dispensing pharmacy is unable to guarantee that the enrollee will receive the 4
self-administered prescription drug in a timely fashion that does not 5
interfere with the environmental storage and transportation requirements 6
denoted by the manufacturer of the pharmaceutical; and 7
(9) Other relevant limitations, including mental health 8
conditions, cognitive or behavioral impairments, or any other factors that 9
impede or put at risk an enrollee's ability to receive, access, or administer 10
his or her self-administered prescription drugs. 11
(b)(1) An enrollee may obtain medications from a pharmacy of his or 12
her choice when healthcare payor affiliate services or pharmacy benefits 13
manager affiliate services are not suitable due to the limitations specified 14
under subsection (a) of this section. 15
(2) A healthcare payor or pharmacy benefits manager shall 16
facilitate access to in -person pharmacy services without imposing additional 17
costs or penalties on the enrollee. 18
(c) A healthcare payor or pharmacy benefits manager shall not mandate 19
the use of a healthcare payor affiliate or pharmacy benefits manager 20
affiliate in cases in which use of a pharmacy benefits manager affiliate or 21
healthcare payor affiliate would adversely affect the enrollee's ability to 22
receive or administer his or her self -administered prescription drug safely 23
and effectively, considering the patient's individual circumstances under 24
subsection (a) of this section as determined by the enrollee's healthcare 25
provider. 26
(d) A healthcare payor and pharmacy benefits manager shall maintain 27
compliance in all dispensing practices with: 28
(1) The prescribing healthcare provider's orders; and 29
(2) All applicable federal and state laws regarding medication 30
dispensing and chain of custody. 31
(e) A healthcare payor or pharmacy benefits manager shall not 32
retaliate against an enrollee or healthcare provider for exercising his or 33
her rights under this section by: 34
(1) Increasing costs; 35
(2) Denying services; or 36 SB104
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(3) Reporting to external agencies. 1
(f) A dispute arising from the enforcement of this section shall be 2
subject to a fair and prompt resolution process as defined by rule by the 3
Insurance Commissioner. 4
(g)(1) The commissioner may promulgate rules necessary to implement, 5
administer, and enforce this section. 6
(2) Rules that the commissioner may adopt under this section 7
include without limitation rules relating to: 8
(A) Resolving disputes that arise from enforcement of this 9
section through a fair and prompt resolution process; and 10
(B) Implementing a penalty structure for a healthcare 11
payor or pharmacy benefits manager that fails to comply with this section 12
that: 13
(i) Is based on the number of Arkansas residents 14
serviced by the healthcare payor or pharmacy benefits manager; and 15
(ii) Does not exceed one hundred thousand dollars 16
($100,000) per violation. 17
18
23-92-515. Self-administered prescription drug — Definition 19
controlling. 20
(a) The definition of "self -administered prescription drug" under this 21
subchapter is controlling, and that defined term shall not be altered, 22
modified, reclassified, relabeled, or reinterpreted by a health benefit plan, 23
healthcare payor, healthcare payor affiliate, pharmacy benefits manager, or 24
pharmacy benefits manager affiliate. 25
(b) A classification, labeling, or interpretation by a health benefit 26
plan, healthcare payor, healthcare payor affiliate, pharmacy benefits 27
manager, or pharmacy benefits manager affiliate does not override or 28
supersede the definition of "self -administered prescription drug" under this 29
subchapter. 30
31
23-92-516. Violation of Deceptive Trade Practices Act — Enforcement. 32
A prohibition of an activity under this subchapter is applicable to a 33
person or entity that: 34
(1) Performs the prohibited activity; 35
(2) Causes another person or entity to perform the prohibited 36 SB104
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activity; 1
(3) Solicits, advises, encourages, or coerces another person or 2
entity to perform the prohibited activity; 3
(4) Aids or attempts to aid another person or entity in 4
performing a prohibited activity; or 5
(5) Indirectly performs the prohibited activity. 6
7
SECTION 5. EMERGENCY CLAUSE. It is found and determined by the 8
General Assembly of the State of Arkansas that an enrollee's access to 9
prescription medications is of immediate concern; that undue restrictions on 10
pharmacies and pharmacists hinder patient care; and that this act is 11
immediately necessary to protect an enrollee's rights and ensure timely 12
access to medications. Therefore, an emergency is declared to exist, and this 13
act being immediately necessary for the preservation of the public peace, 14
health, and safety shall become effective on: 15
(1) The date of its approval by the Governor; 16
(2) If the bill is neither approved nor vetoed by the Governor, 17
the expiration of the period of time during which the Governor may veto the 18
bill; or 19
(3) If the bill is vetoed by the Governor and the veto is 20
overridden, the date the last house overrides the veto. 21
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