AR
Arkansas Senate Bill SB104

Arkansas 2025 Regular Session

Arkansas Senate Bill SB104 Compare Versions

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11 Stricken language would be deleted from and underlined language would be added to present law.
2-Act 514 of the Regular Session
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4-
5-State of Arkansas As Engrossed: H3/19/25 H4/1/25 1
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3+State of Arkansas 1
64 95th General Assembly A Bill 2
75 Regular Session, 2025 SENATE BILL 104 3
86 4
9-By: Senators C. Penzo, M. Johnson 5
7+By: Senator C. Penzo 5
108 By: Representative Lundstrum 6
119 7
1210 For An Act To Be Entitled 8
1311 AN ACT TO AMEND THE ARKANSAS PHARMACY BENEFITS 9
1412 MANAGER LICENSURE ACT; TO PROTECT PATIENTS' RIGHTS 10
1513 AND ACCESS TO MEDICATIONS; TO DECLARE AN EMERGENCY; 11
1614 AND FOR OTHER PURPOSES. 12
1715 13
1816 14
1917 Subtitle 15
2018 TO AMEND THE ARKANSAS PHARMACY BENEFITS 16
2119 MANAGER LICENSURE ACT; TO PROTECT 17
2220 PATIENTS' RIGHTS AND ACCESS TO 18
2321 MEDICATIONS; AND TO DECLARE AN 19
2422 EMERGENCY. 20
2523 21
2624 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS: 22
2725 23
2826 SECTION 1. DO NOT CODIFY. Legislative intent. 24
2927 It is the intent of the General Assembly that this act shall regulate 25
3028 the business practices of healthcare payors and pharmacy benefits managers: 26
3129 (1) To ensure adequate access to pharmacy services as intended 27
3230 and designed by underlying health benefit plans; 28
3331 (2) To protect patients from unfair and deceptive trade 29
3432 practices within the state; and 30
3533 (3) To ensure pharmacy benefits management companies do not 31
3634 interfere with a patient's rights under the patient's underlying health 32
3735 benefit plan and always consider each patient's unique conditions and 33
3836 limitations when enforcing any access prerequisites or conditions. 34
3937 35
40- SECTION 2. Arkansas Code § 23 -92-503, concerning the definitions used 36 As Engrossed: H3/19/25 H4/1/25 SB104
38+ SECTION 2. Arkansas Code § 23 -92-503, concerning the definitions used 36 SB104
4139
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43-
44-
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4541 in the Arkansas Pharmacy Benefits Manager Licensure Act, is amended to add 1
4642 additional subdivisions to read as follows: 2
47- (16)(A) "Affiliate" means an entity that controls, is controlled 3
43+ (16) "Affiliate" means an entity that controls, is controlled 3
4844 by, or is under common control with another entity, including an entity in 4
4945 which control is established through one (1) or more intermediary entities, 5
5046 such that the common controlling interest may be two (2) or more levels 6
51-removed from the specified entity. 7
52- (B) Whether an entity is an "affiliate" does not depend on 8
53-the percentage or form of ownership interest or any allocation of membership 9
54-or ownership between entities, but it is the existence of control or common 10
55-control that is the sole determinative factor; 11
56- (17)(A) "Carve-out network" means a subset of a pharmacy 12
57-benefits manager's network that: 13
58- (i) Is created by the pharmacy benefits manager; and 14
59- (ii) Limits access to a certain pharmacy or 15
60-pharmacist for a specific drug or category of drugs. 16
61- (B) "Carve-out network" includes any network that 17
62-restricts enrollee access to in -person pharmacy services within this state by 18
63-offering only limited methods of obtaining a prescription drug, including 19
64-mail-order only options, while presenting the appearance of a full network of 20
65-available pharmacies; 21
66- (18) "Enrollee" means an individual who is entitled to receive 22
67-healthcare services under the terms of a health benefit plan; 23
68- (19)(A) "Ghost network" means a pharmacy benefits manager 24
69-network that includes a pharmacy or pharmacist as a participating provider 25
70-when that participating provider is: 26
71- (i) Not accepting new patients; 27
72- (ii) No longer in practice; or 28
73- (iii) Otherwise unavailable to or restricted from 29
74-providing services to enrollees in this state. 30
75- (B) "Ghost network" includes a pharmacy network in which a 31
76-significant number of listed participating providers are not accessible to 32
77-enrollees within a reasonable time frame or geographic distance; 33
78- (20) "Healthcare payor affiliate" means a pharmacy or pharmacist 34
79-that directly or indirectly, through one (1) or more intermediaries, owns or 35
80-controls, is owned or controlled by, or is under common ownership or control 36 As Engrossed: H3/19/25 H4/1/25 SB104
47+removed from the specified entity; 7
48+ (17)(A) "Carve-out network" means a subset of a pharmacy 8
49+benefits manager's network that: 9
50+ (i) Is created by the pharmacy benefits manager; and 10
51+ (ii) Limits access to a certain pharmacy or 11
52+pharmacist for a specific drug or category of drugs. 12
53+ (B) "Carve-out network" includes any network that 13
54+restricts enrollee access to in -person pharmacy services within this state by 14
55+offering only limited methods of obtaining a prescription drug, including 15
56+mail-order only options, while presenting the appearance of a full network of 16
57+available pharmacies; 17
58+ (18) "Enrollee" means an individual who is entitled to receive 18
59+healthcare services under the terms of a health benefit plan; 19
60+ (19)(A) "Ghost network" means a pharmacy benefits manager 20
61+network that includes a pharmacy or pharmacist as a participating provider 21
62+when that participating provider is: 22
63+ (i) Not accepting new patients; 23
64+ (ii) No longer in practice; or 24
65+ (iii) Otherwise unavailable to or restricted from 25
66+providing services to enrollees in this state. 26
67+ (B) "Ghost network" includes a pharmacy network in which a 27
68+significant number of listed participating providers are not accessible to 28
69+enrollees within a reasonable time frame or geographic distance; 29
70+ (20) "Healthcare payor affiliate" means a pharmacy or pharmacist 30
71+that directly or indirectly, through one (1) or more intermediaries, owns or 31
72+controls, is owned or controlled by, or is under common ownership or control 32
73+with a healthcare payor; and 33
74+ (21)(A) "Self-administered prescription drug" means a 34
75+pharmaceutical that when prescribed does not require assistance by a third 35
76+party to administer and can be dispensed by a pharmacy or pharmacist to an 36 SB104
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79+enrollee for self-administration under federal and state laws and 1
80+regulations. 2
81+ (B) "Self-administered prescription drug" does not include 3
82+over-the-counter medications that do not require a prescription. 4
83+ 5
84+ SECTION 3. Arkansas Code § 23 -92-506(b), concerning prohibited 6
85+practices under the Arkansas Pharmacy Benefits Manager Licensure Act, is 7
86+amended to add an additional subdivision to read as follows: 8
87+ (9) Unless reviewed and approved by the commissioner in 9
88+coordination with the board, require pharmacy accreditation standards or 10
89+certification requirements inconsistent with, more stringent than, or in 11
90+addition to requirements of the board. 12
91+ 13
92+ SECTION 4. Arkansas Code Title 23, Chapter 92, Subchapter 5, is 14
93+amended to add additional sections to read as follows: 15
94+ 23-92-512. Unfair and deceptive trade practices. 16
95+ (a)(1) A healthcare payor, healthcare payor affiliate, pharmacy 17
96+benefits manager, or pharmacy benefits manager affiliate shall not engage in 18
97+unfair or deceptive trade practices in the administration of pharmacy 19
98+benefits. 20
99+ (2) Unfair or deceptive trade practices under subdivision (a)(1) 21
100+of this section include without limitation: 22
101+ (A) Requiring an enrollee to utilize a particular 23
102+healthcare payor affiliate or pharmacy benefits manager affiliate; 24
103+ (B) Requiring a pharmacy or pharmacist to forward or 25
104+retransmit a prescription to a specific healthcare payor affiliate or 26
105+pharmacy benefits manager affiliate unless the receiving healthcare payor 27
106+affiliate or pharmacy benefits manager affiliate can provide verifiable 28
107+documentation of the enrollee's consent to use that specific pharmacy; 29
108+ (C) Implementing a policy or protocol that unreasonably 30
109+restricts an enrollee's choice of pharmacy within the pharmacy benefits 31
110+manager network, if: 32
111+ (i)(a) The pharmacy meets the pharmacy benefits 33
112+manager network's relevant and reasonable terms of participation 34
113+requirements. 35
114+ (b) A disagreement or concern regarding 36 SB104
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117+whether relevant and reasonable terms of participation requirements are 1
118+relevant and reasonable shall be determined by the Insurance Commissioner; 2
119+and 3
120+ (ii) The pharmacy has existing approval to dispense 4
121+one (1) or more self -administered prescription drugs in the pharmacy benefits 5
122+manager network or one (1) or more networks for the underlying health benefit 6
123+plan; 7
124+ (D)(i) Providing an incentive or imposing a penalty that 8
125+effectively coerces or pressures an enrollee to use a particular healthcare 9
126+payor affiliate or pharmacy benefits manager affiliate. 10
127+ (ii) Adjustments to an enrollee's cost -sharing 11
128+responsibilities, including copayments, coinsurance, or deductibles, that are 12
129+part of the health benefit plan's design are not considered incentives or 13
130+penalties under subdivision (a)(2)(D)(i) of this section; 14
131+ (E) Failing to disclose to an enrollee the options 15
132+available for obtaining prescription drugs within the pharmacy benefits 16
133+manager network; 17
134+ (F) Disclosing, sharing, or otherwise making available 18
135+enrollee information or enrollee -identifiable prescription information 19
136+submitted by a pharmacist or pharmacy to a healthcare payor affiliate or 20
137+pharmacy benefits manager affiliate without the written consent of the 21
138+enrollee; 22
139+ (G) Using or disclosing enrollee information or enrollee -23
140+identifiable prescription information for marketing or solicitation purposes 24
141+without the written consent of the enrollee; and 25
142+ (H)(i) Engaging in any conduct that unlawfully restricts, 26
143+limits, or interferes with an enrollee's right to choose a pharmacy or 27
144+pharmacist, including without limitation actions that violate federal law or 28
145+state law or improperly steer enrollees to a specific pharmacy or pharmacist. 29
146+ (ii) The prohibition under subdivision (a)(2)(H)(i) 30
147+of this section does not apply to a change in patient cost -sharing 31
148+obligations, including copayments, coinsurance, or deductibles, that are 32
149+permitted under applicable law. 33
150+ (b)(1) A healthcare payor, healthcare payor affiliate, pharmacy 34
151+benefits manager, or pharmacy benefits manager affiliate shall not impose 35
152+restrictive terms or conditions that limit an enrollee's or an enrollee’s 36 SB104
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85-with a healthcare payor; and 1
86- (21)(A) "Self-administered prescription drug" means a 2
87-pharmaceutical that when prescribed does not require assistance by a third 3
88-party to administer and can be dispensed by a pharmacy or pharmacist to an 4
89-enrollee for self-administration under federal and state laws and 5
90-regulations. 6
91- (B) "Self-administered prescription drug" does not include 7
92-over-the-counter medications that do not require a prescription. 8
93- 9
94- SECTION 3. Arkansas Code § 23 -92-506(b), concerning prohibited 10
95-practices under the Arkansas Pharmacy Benefits Manager Licensure Act, is 11
96-amended to add an additional subdivision to read as follows: 12
97- (9) Unless reviewed and approved by the commissioner in 13
98-coordination with the board, require pharmacy accreditation standards or 14
99-certification requirements inconsistent with, more stringent than, or in 15
100-addition to requirements of the board. 16
101- 17
102- SECTION 4. Arkansas Code Title 23, Chapter 92, Subchapter 5, is 18
103-amended to add additional sections to read as follows: 19
104- 23-92-512. Unfair and deceptive trade practices. 20
105- (a)(1) A healthcare payor, healthcare payor affiliate, pharmacy 21
106-benefits manager, or pharmacy benefits manager affiliate shall not engage in 22
107-unfair or deceptive trade practices in the administration of pharmacy 23
108-benefits. 24
109- (2) Unfair or deceptive trade practices under subdivision (a)(1) 25
110-of this section include without limitation: 26
111- (A) Requiring an enrollee to utilize a particular 27
112-pharmacy benefits manager affiliate; 28
113- (B) Requiring a pharmacy or pharmacist to forward or 29
114-retransmit a prescription to a specific healthcare payor affiliate or 30
115-pharmacy benefits manager affiliate unless the receiving healthcare payor 31
116-affiliate or pharmacy benefits manager affiliate can provide verifiable 32
117-documentation of the enrollee's consent to use that specific pharmacy; 33
118- (C) Implementing a policy or protocol that unreasonably 34
119-restricts an enrollee's choice of pharmacy within a pharmacy benefits manager 35
120-network, if: 36 As Engrossed: H3/19/25 H4/1/25 SB104
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155+assigned representative’s rights to seek an exception to or to appeal a 1
156+coverage decision or restriction with his or her health benefit plan. 2
157+ (2) A healthcare payor, healthcare payor affiliate, pharmacy 3
158+benefits manager, or pharmacy benefits manager affiliate shall ensure that: 4
159+ (A) The processes for seeking an exception and filing an 5
160+appeal are clearly communicated to patients in a publicly accessible manner 6
161+on its website; 7
162+ (B) The information necessary to utilize the processes 8
163+under subdivision (b)(2)(A) of this section is presented in a manner that is 9
164+understandable and not hidden or obscured; and 10
165+ (C) An enrollee is not hindered or obstructed from 11
166+exercising the rights granted to the enrollee under the enrollee's health 12
167+benefit plan. 13
168+ (c)(1) A healthcare payor shall not prohibit, restrict, or impede an 14
169+enrollee’s or an enrollee’s authorized representative’s ability to: 15
170+ (A) Discuss the enrollee's health benefit plan, including 16
171+prescription drug benefits, with the healthcare payor or its authorized 17
172+representatives; 18
173+ (B) Obtain necessary exceptions, approvals, 19
174+authorizations, or related information to access the enrollee's benefits; or 20
175+ (C) Appeal decisions regarding the enrollee's benefits 21
176+coverage decisions as provided under the terms of the enrollee's health 22
177+benefit plan. 23
178+ (2) The healthcare payor shall ensure that an enrollee has 24
179+reasonable access to the discussions, approvals, and appeals processes 25
180+regardless of the pharmacy benefits manager, affiliate, or third -party 26
181+administrator selected to administer prescription benefits. 27
182+ (3) It is an unfair and deceptive trade practice for a 28
183+healthcare payor to delegate responsibilities in a manner that obstructs, 29
184+hinders, or prevents an enrollee from exercising the enrollee's rights under 30
185+his or her health benefit plan. 31
186+ (d)(1) A pharmacy benefits manager and pharmacy benefits manager 32
187+affiliate shall adhere to all applicable federal and state privacy laws when 33
188+communicating with an enrollee. 34
189+ (2) A pharmacy benefits manager and pharmacy benefits manager 35
190+affiliate shall not use enrollee information for marketing purposes without 36 SB104
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193+the written consent of the enrollee. 1
194+ (e) A pharmacy benefits manager and pharmacy benefits manager 2
195+affiliate shall comply with the timely processing of complaints and appeals 3
196+as established by rule of the commissioner. 4
197+ (f)(1) The commissioner may promulgate rules necessary to implement, 5
198+administer, and enforce this section. 6
199+ (2) Rules that the commissioner may adopt under this section 7
200+include without limitation rules relating to implementing a penalty structure 8
201+for a healthcare payor, healthcare payor affiliate, pharmacy benefits 9
202+manager, or pharmacy benefits manager affiliate that fails to comply with 10
203+this section that is based on the number of Arkansas residents serviced by 11
204+the healthcare payor, healthcare payor affiliate, pharmacy benefits manager, 12
205+or pharmacy benefits manager affiliate. 13
206+ (g)(1) A violation of this subchapter is an unfair and deceptive act 14
207+or practice as defined by the Deceptive Trade Practices Act, § 4 -88-101 et 15
208+seq. 16
209+ (2) All remedies, penalties, and authority granted to the 17
210+Attorney General under the Deceptive Trade Practices Act, § 4 -88-101 et seq., 18
211+shall be available to the Attorney General for the enforcement of this 19
212+subchapter. 20
213+ 21
214+ 23-92-513. Prohibition of ghost networks. 22
215+ (a) A pharmacy benefits manager shall not create, utilize, or maintain 23
216+a ghost network within this state. 24
217+ (b) A healthcare payor or pharmacy benefits manager shall not create, 25
218+utilize, or maintain a carve -out network within this state by: 26
219+ (1) Limiting enrollee access to specific pharmacies or 27
220+pharmacists for self -administered prescription drugs when an enrollee is 28
221+directed to use a healthcare payor affiliate, pharmacy benefits manager 29
222+affiliate, or other limited option while the pharmacy benefits manager 30
223+network appears to offer a full range of pharmacist services; 31
224+ (2) Failing to provide adequate access to in -person pharmacy 32
225+services within this state for all covered self -administered prescription 33
226+drugs; or 34
227+ (3) Representing that a broad network of pharmacies or 35
228+pharmacists is available if, in practice, access to certain self -administered 36 SB104
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231+prescription drugs is restricted to a carve -out network that lacks sufficient 1
232+in-state providers accessible to an enrollee. 2
233+ (c) A healthcare payor or pharmacy benefits manager shall ensure that 3
234+its pharmacy benefits manager network of participating pharmacists and 4
235+pharmacies: 5
236+ (1) Accurately reflects the availability of pharmacists and 6
237+pharmacies actively accepting new patients; 7
238+ (2) Provides an enrollee with reasonable access to pharmacist 8
239+services within this state, including options for in -person consultations and 9
240+medication pickup from a licensed pharmacist or pharmacy in this state; 10
241+ (3) Is not solely serviced by a mail -order pharmacy; and 11
242+ (4) Is not solely serviced by a pharmacy benefits manager 12
243+affiliate or healthcare payor affiliate. 13
244+ (d) A healthcare payor or pharmacy benefits manager shall: 14
245+ (1) Regularly verify and update its pharmacy benefits manager 15
246+network directory to reflect the current availability of participating 16
247+pharmacists and pharmacies; 17
248+ (2) Remove a pharmacist or pharmacy from its pharmacy benefits 18
249+manager network directory if that pharmacist or pharmacy is: 19
250+ (A) Not accepting new patients; 20
251+ (B) No longer in practice; or 21
252+ (C) Otherwise unavailable to provide services; and 22
253+ (3) Provide accurate and accessible information to an enrollee 23
254+regarding participating pharmacists and pharmacies within the pharmacy 24
255+benefits manager network in a publicly accessible manner on its website. 25
256+ (e)(1) The Insurance Commissioner may promulgate rules necessary to 26
257+implement, administer, and enforce this section. 27
258+ (2) Rules that the commissioner may adopt under this section 28
259+include without limitation rules relating to: 29
260+ (A) Requiring a healthcare payor and pharmacy benefits 30
261+manager to submit periodic reports on pharmacy benefits manager network 31
262+adequacy and accessibility; 32
263+ (B) Investigating a complaint regarding a ghost network 33
264+and taking appropriate enforcement action; and 34
265+ (C) Implementing a penalty structure for a healthcare 35
266+payor or pharmacy benefits manager that fails to comply with this section 36 SB104
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125- (i)(a) The pharmacy meets the pharmacy benefits 1
126-manager network's relevant and reasonable terms of participation 2
127-requirements. 3
128- (b) A disagreement or concern regarding 4
129-whether relevant and reasonable terms of participation requirements are 5
130-relevant and reasonable shall be determined by the Insurance Commissioner; 6
131-and 7
132- (ii) The pharmacy has existing approval to dispense 8
133-one (1) or more self -administered prescription drugs in one (1) or more 9
134-pharmacy benefits manager networks for the underlying health benefit plan; 10
135- (D)(i) Providing an incentive or imposing a penalty that 11
136-effectively coerces or pressures an enrollee to use a particular healthcare 12
137-payor affiliate or pharmacy benefits manager affiliate. 13
138- (ii) Adjustments to an enrollee's cost -sharing 14
139-responsibilities, including copayments, coinsurance, or deductibles, that are 15
140-part of the health benefit plan's design are not considered incentives or 16
141-penalties under subdivision (a)(2)(D)(i) of this section; 17
142- (E) Failing to disclose to an enrollee the options 18
143-available for obtaining prescription drugs within the pharmacy benefits 19
144-manager network; 20
145- (F) Disclosing, sharing, or otherwise making available 21
146-enrollee information or enrollee -identifiable prescription information 22
147-submitted by a pharmacist or pharmacy to a healthcare payor affiliate or 23
148-pharmacy benefits manager affiliate without the written consent of the 24
149-enrollee; 25
150- (G) Using or disclosing enrollee information or enrollee -26
151-identifiable prescription information for marketing or solicitation purposes 27
152-without the written consent of the enrollee; and 28
153- (H)(i) Engaging in any conduct that unlawfully restricts, 29
154-limits, or interferes with an enrollee's right to choose a pharmacy or 30
155-pharmacist, including without limitation actions that violate federal law or 31
156-state law or improperly steer enrollees to a specific pharmacy or pharmacist. 32
157- (ii) The prohibition under subdivision (a)(2)(H)(i) 33
158-of this section does not apply to a change in patient cost -sharing 34
159-obligations, including copayments, coinsurance, or deductibles, that are 35
160-permitted under applicable law. 36 As Engrossed: H3/19/25 H4/1/25 SB104
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269+that: 1
270+ (i) Is based on the number of Arkansas residents 2
271+serviced by the healthcare payor or pharmacy benefits manager; and 3
272+ (ii) Does not exceed one hundred thousand dollars 4
273+($100,000) per violation. 5
274+ 6
275+ 23-92-514. Patient accommodation and nonrestriction clause. 7
276+ (a) A healthcare payor or pharmacy benefits manager shall not enforce 8
277+the use of a particular healthcare payor affiliate or pharmacy benefits 9
278+manager affiliate or otherwise restrict an enrollee's choice of pharmacist or 10
279+pharmacy without considering the enrollee's individual limitations, including 11
280+without limitation: 12
281+ (1) Medical limitations, including chronic illnesses, temporary 13
282+or permanent disabilities, or conditions requiring specialized care or that 14
283+impair cognitive or motor functions; 15
284+ (2) Complex therapies, when the self -administered prescription 16
285+drug is one (1) of multiple pharmaceuticals provided to an enrollee receiving 17
286+treatment and mailing the individual pharmaceutical has the potential to 18
287+interfere with the appropriate and timely administration requirements; 19
288+ (3) Physical limitations, including mobility impairments or 20
289+inability to retrieve mail or other deliveries without assistance or risk for 21
290+physical harm to self while retrieving mail or other deliveries; 22
291+ (4) Socioeconomic limitations, including financial hardships, 23
292+lack of reliable transportation, lack of a caregiver, or other socioeconomic 24
293+barriers that may prohibit an enrollee from being present during delivery or 25
294+prohibit an enrollee from accessing the delivery location; 26
295+ (5) Housing limitations, including homelessness, medical 27
296+confinement, incarceration, unstable housing situations, residences without 28
297+secure mail delivery options, or residences with shared mail facilities; 29
298+ (6) Chain of custody, when a dispensing pharmacy cannot 30
299+guarantee that the recipient of the self -administered prescription drug will 31
300+be present according to federal and state laws and regulations; 32
301+ (7) Prescribing provider order contradictions, when the 33
302+dispensing pharmacy is unable to guarantee that the prescribing provider's 34
303+orders will be followed if the self -administered prescription drug is 35
304+delivered, including situations in which the prescribing provider requires 36 SB104
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307+administration under direct supervision of a medical professional for a 1
308+customarily self-administered prescription drug; 2
309+ (8) Medication storage and efficacy concerns, when the 3
310+dispensing pharmacy is unable to guarantee that the enrollee will receive the 4
311+self-administered prescription drug in a timely fashion that does not 5
312+interfere with the environmental storage and transportation requirements 6
313+denoted by the manufacturer of the pharmaceutical; and 7
314+ (9) Other relevant limitations, including mental health 8
315+conditions, cognitive or behavioral impairments, or any other factors that 9
316+impede or put at risk an enrollee's ability to receive, access, or administer 10
317+his or her self-administered prescription drugs. 11
318+ (b)(1) An enrollee may obtain medications from a pharmacy of his or 12
319+her choice when healthcare payor affiliate services or pharmacy benefits 13
320+manager affiliate services are not suitable due to the limitations specified 14
321+under subsection (a) of this section. 15
322+ (2) A healthcare payor or pharmacy benefits manager shall 16
323+facilitate access to in -person pharmacy services without imposing additional 17
324+costs or penalties on the enrollee. 18
325+ (c) A healthcare payor or pharmacy benefits manager shall not mandate 19
326+the use of a healthcare payor affiliate or pharmacy benefits manager 20
327+affiliate in cases in which use of a pharmacy benefits manager affiliate or 21
328+healthcare payor affiliate would adversely affect the enrollee's ability to 22
329+receive or administer his or her self -administered prescription drug safely 23
330+and effectively, considering the patient's individual circumstances under 24
331+subsection (a) of this section as determined by the enrollee's healthcare 25
332+provider. 26
333+ (d) A healthcare payor and pharmacy benefits manager shall maintain 27
334+compliance in all dispensing practices with: 28
335+ (1) The prescribing healthcare provider's orders; and 29
336+ (2) All applicable federal and state laws regarding medication 30
337+dispensing and chain of custody. 31
338+ (e) A healthcare payor or pharmacy benefits manager shall not 32
339+retaliate against an enrollee or healthcare provider for exercising his or 33
340+her rights under this section by: 34
341+ (1) Increasing costs; 35
342+ (2) Denying services; or 36 SB104
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345+ (3) Reporting to external agencies. 1
346+ (f) A dispute arising from the enforcement of this section shall be 2
347+subject to a fair and prompt resolution process as defined by rule by the 3
348+Insurance Commissioner. 4
349+ (g)(1) The commissioner may promulgate rules necessary to implement, 5
350+administer, and enforce this section. 6
351+ (2) Rules that the commissioner may adopt under this section 7
352+include without limitation rules relating to: 8
353+ (A) Resolving disputes that arise from enforcement of this 9
354+section through a fair and prompt resolution process; and 10
355+ (B) Implementing a penalty structure for a healthcare 11
356+payor or pharmacy benefits manager that fails to comply with this section 12
357+that: 13
358+ (i) Is based on the number of Arkansas residents 14
359+serviced by the healthcare payor or pharmacy benefits manager; and 15
360+ (ii) Does not exceed one hundred thousand dollars 16
361+($100,000) per violation. 17
362+ 18
363+ 23-92-515. Self-administered prescription drug — Definition 19
364+controlling. 20
365+ (a) The definition of "self -administered prescription drug" under this 21
366+subchapter is controlling, and that defined term shall not be altered, 22
367+modified, reclassified, relabeled, or reinterpreted by a health benefit plan, 23
368+healthcare payor, healthcare payor affiliate, pharmacy benefits manager, or 24
369+pharmacy benefits manager affiliate. 25
370+ (b) A classification, labeling, or interpretation by a health benefit 26
371+plan, healthcare payor, healthcare payor affiliate, pharmacy benefits 27
372+manager, or pharmacy benefits manager affiliate does not override or 28
373+supersede the definition of "self -administered prescription drug" under this 29
374+subchapter. 30
375+ 31
376+ 23-92-516. Violation of Deceptive Trade Practices Act — Enforcement. 32
377+ A prohibition of an activity under this subchapter is applicable to a 33
378+person or entity that: 34
379+ (1) Performs the prohibited activity; 35
380+ (2) Causes another person or entity to perform the prohibited 36 SB104
164381
165- (b)(1) A healthcare payor, healthcare payor affiliate, pharmacy 1
166-benefits manager, or pharmacy benefits manager affiliate shall not impose 2
167-restrictive terms or conditions that limit an enrollee's or an enrollee’s 3
168-assigned representative’s rights to seek an exception to or to appeal a 4
169-coverage decision or restriction with his or her health benefit plan. 5
170- (2) A healthcare payor, healthcare payor affiliate, pharmacy 6
171-benefits manager, or pharmacy benefits manager affiliate shall ensure that: 7
172- (A) The processes for seeking an exception and filing an 8
173-appeal are clearly communicated to patients in a publicly accessible manner 9
174-on its website; 10
175- (B) The information necessary to utilize the processes 11
176-under subdivision (b)(2)(A) of this section is presented in a manner that is 12
177-understandable and not hidden or obscured; and 13
178- (C) An enrollee is not hindered or obstructed from 14
179-exercising the rights granted to the enrollee under the enrollee's health 15
180-benefit plan. 16
181- (c)(1) A healthcare payor shall not prohibit, restrict, or impede an 17
182-enrollee’s or an enrollee’s authorized representative’s ability to: 18
183- (A) Discuss the enrollee's health benefit plan, including 19
184-prescription drug benefits, with the healthcare payor or its authorized 20
185-representatives; 21
186- (B) Obtain necessary exceptions, approvals, 22
187-authorizations, or related information to access the enrollee's benefits; or 23
188- (C) Appeal decisions regarding the enrollee's benefits 24
189-coverage decisions as provided under the terms of the enrollee's health 25
190-benefit plan. 26
191- (2) The healthcare payor shall ensure that an enrollee has 27
192-reasonable access to the discussions, approvals, and appeals processes 28
193-regardless of the pharmacy benefits manager, affiliate, or third -party 29
194-administrator selected to administer prescription benefits. 30
195- (3) It is an unfair and deceptive trade practice for a 31
196-healthcare payor to delegate responsibilities in a manner that obstructs, 32
197-hinders, or prevents an enrollee from exercising the enrollee's rights under 33
198-his or her health benefit plan. 34
199- (d)(1) A pharmacy benefits manager and pharmacy benefits manager 35
200-affiliate shall adhere to all applicable federal and state privacy laws when 36 As Engrossed: H3/19/25 H4/1/25 SB104
201-
202- 6 04-01-2025 14:34:50 ANS087
203-
204-
205-communicating with an enrollee. 1
206- (2) A pharmacy benefits manager and pharmacy benefits manager 2
207-affiliate shall not use enrollee information for marketing purposes without 3
208-the written consent of the enrollee. 4
209- (e) A pharmacy benefits manager and pharmacy benefits manager 5
210-affiliate shall comply with the timely processing of complaints and appeals 6
211-as established by rule of the commissioner. 7
212- (f)(1) The commissioner may promulgate rules necessary to implement, 8
213-administer, and enforce this section. 9
214- (2) Rules that the commissioner may adopt under this section 10
215-include without limitation rules relating to implementing a penalty structure 11
216-for a healthcare payor, healthcare payor affiliate, pharmacy benefits 12
217-manager, or pharmacy benefits manager affiliate that fails to comply with 13
218-this section that is based on the number of Arkansas residents serviced by 14
219-the healthcare payor, healthcare payor affiliate, pharmacy benefits manager, 15
220-or pharmacy benefits manager affiliate. 16
221- (g)(1) A violation of this subchapter is an unfair and deceptive act 17
222-or practice as defined by the Deceptive Trade Practices Act, § 4 -88-101 et 18
223-seq. 19
224- (2) All remedies, penalties, and authority granted to the 20
225-Attorney General under the Deceptive Trade Practices Act, § 4 -88-101 et seq., 21
226-shall be available to the Attorney General for the enforcement of this 22
227-subchapter. 23
382+ 11 01/27/2025 7:44:32 AM ANS087
383+activity; 1
384+ (3) Solicits, advises, encourages, or coerces another person or 2
385+entity to perform the prohibited activity; 3
386+ (4) Aids or attempts to aid another person or entity in 4
387+performing a prohibited activity; or 5
388+ (5) Indirectly performs the prohibited activity. 6
389+ 7
390+ SECTION 5. EMERGENCY CLAUSE. It is found and determined by the 8
391+General Assembly of the State of Arkansas that an enrollee's access to 9
392+prescription medications is of immediate concern; that undue restrictions on 10
393+pharmacies and pharmacists hinder patient care; and that this act is 11
394+immediately necessary to protect an enrollee's rights and ensure timely 12
395+access to medications. Therefore, an emergency is declared to exist, and this 13
396+act being immediately necessary for the preservation of the public peace, 14
397+health, and safety shall become effective on: 15
398+ (1) The date of its approval by the Governor; 16
399+ (2) If the bill is neither approved nor vetoed by the Governor, 17
400+the expiration of the period of time during which the Governor may veto the 18
401+bill; or 19
402+ (3) If the bill is vetoed by the Governor and the veto is 20
403+overridden, the date the last house overrides the veto. 21
404+ 22
405+ 23
228406 24
229- 23-92-513. Prohibition of ghost networks. 25
230- (a)(1) A pharmacy benefits manager shall not create, utilize, or 26
231-maintain a ghost network within this state. 27
232- (2) For purposes of this section, a network shall not be 28
233-considered a ghost network if the network includes at least one (1) mail -29
234-order pharmacy option and one (1) in -person pharmacy option that is 30
235-physically located in this state if both the mail -order pharmacy option and 31
236-the in-person pharmacy option are: 32
237- (A) Accepting new patients; and 33
238- (B) Otherwise available to an enrollee in this state. 34
239- (b)(1) A healthcare payor or pharmacy benefits manager shall not 35
240-create, utilize, or maintain a carve -out network within this state by: 36 As Engrossed: H3/19/25 H4/1/25 SB104
241-
242- 7 04-01-2025 14:34:50 ANS087
243-
244-
245- (A) Limiting enrollee access to specific pharmacies or 1
246-pharmacists for self -administered prescription drugs when an enrollee is 2
247-directed to use a healthcare payor affiliate, pharmacy benefits manager 3
248-affiliate, or other limited option while the pharmacy benefits manager 4
249-network appears to offer a full range of pharmacist services; 5
250- (B) Failing to provide adequate access to pharmacy services for 6
251-all covered self-administered prescription drugs, including through a 7
252-licensed pharmacy physically located within this state; or 8
253- (C) Representing that a broad network of pharmacies or 9
254-pharmacists is available if, in practice, access to certain self -administered 10
255-prescription drugs is restricted to a carve -out network that lacks sufficient 11
256-in-state providers accessible to an enrollee. 12
257- (2) For purposes of this section, a network shall not be 13
258-considered a carve-out network if the network includes at least one (1) mail -14
259-order pharmacy option and one (1) in -person pharmacy option that is 15
260-physically located in this state if both the mail -order pharmacy option and 16
261-the in-person pharmacy option are: 17
262- (A) Accepting new patients; and 18
263- (B) Otherwise available to an enrollee in this state.19
264- (c) A healthcare payor or pharmacy benefits manager shall ensure that 20
265-its pharmacy benefits manager network of participating pharmacists and 21
266-pharmacies: 22
267- (1) Accurately reflects the availability of pharmacists and 23
268-pharmacies actively accepting new patients; 24
269- (2) Provides an enrollee with reasonable access to pharmacist 25
270-services within this state, including options for in -person consultations and 26
271-medication pickup from a licensed pharmacist or pharmacy in this state; 27
272- (3) Is not solely serviced by a mail -order pharmacy; and 28
273- (4) Is not solely serviced by a pharmacy benefits manager 29
274-affiliate or healthcare payor affiliate. 30
275- (d) A healthcare payor or pharmacy benefits manager shall: 31
276- (1) Regularly verify and update its pharmacy benefits manager 32
277-network directory to reflect the current availability of participating 33
278-pharmacists and pharmacies; 34
279- (2) Remove a pharmacist or pharmacy from its pharmacy benefits 35
280-manager network directory if that pharmacist or pharmacy is: 36 As Engrossed: H3/19/25 H4/1/25 SB104
281-
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283-
284-
285- (A) Not accepting new patients; 1
286- (B) No longer in practice; or 2
287- (C) Otherwise unavailable to provide services; and 3
288- (3) Provide accurate and accessible information to an enrollee 4
289-regarding participating pharmacists and pharmacies within the pharmacy 5
290-benefits manager network in a publicly accessible manner on its website. 6
291- (e)(1) The Insurance Commissioner may promulgate rules necessary to 7
292-implement, administer, and enforce this section. 8
293- (2) Rules that the commissioner may adopt under this section 9
294-include without limitation rules relating to: 10
295- (A) Requiring a healthcare payor and pharmacy benefits 11
296-manager to submit periodic reports on pharmacy benefits manager network 12
297-adequacy and accessibility; 13
298- (B) Investigating a complaint regarding a ghost network 14
299-and taking appropriate enforcement action; and 15
300- (C) Implementing a penalty structure for a healthcare 16
301-payor or pharmacy benefits manager that fails to comply with this section 17
302-that: 18
303- (i) Is based on the number of Arkansas residents 19
304-serviced by the healthcare payor or pharmacy benefits manager; and 20
305- (ii) Does not exceed one hundred thousand dollars 21
306-($100,000) per violation. 22
307- 23
308- 23-92-514. Patient accommodation and nonrestriction clause. 24
309- (a) A healthcare payor or pharmacy benefits manager shall not enforce 25
310-the use of a particular healthcare payor affiliate or pharmacy benefits 26
311-manager affiliate without considering the enrollee's individual limitations, 27
312-including without limitation: 28
313- (1) Medical limitations, including chronic illnesses, temporary 29
314-or permanent disabilities, or conditions requiring specialized care or that 30
315-impair cognitive or motor functions; 31
316- (2) Complex therapies, when the self -administered prescription 32
317-drug is one (1) of multiple pharmaceuticals provided to an enrollee receiving 33
318-treatment and mailing the individual pharmaceutical has the potential to 34
319-interfere with the appropriate and timely administration requirements; 35
320- (3) Physical limitations, including mobility impairments or 36 As Engrossed: H3/19/25 H4/1/25 SB104
321-
322- 9 04-01-2025 14:34:50 ANS087
323-
324-
325-inability to retrieve mail or other deliveries without assistance or risk for 1
326-physical harm to self while retrieving mail or other deliveries; 2
327- (4) Socioeconomic limitations, including financial hardships, 3
328-lack of reliable transportation, lack of a caregiver, or other socioeconomic 4
329-barriers that may prohibit an enrollee from being present during delivery or 5
330-prohibit an enrollee from accessing the delivery location; 6
331- (5) Housing limitations, including homelessness, medical 7
332-confinement, incarceration, unstable housing situations, residences without 8
333-secure mail delivery options, or residences with shared mail facilities; 9
334- (6) Chain of custody, when a dispensing pharmacy cannot 10
335-guarantee that the recipient of the self -administered prescription drug will 11
336-be present according to federal and state laws and regulations; 12
337- (7) Prescribing provider order contradictions, when the 13
338-dispensing pharmacy is unable to guarantee that the prescribing provider's 14
339-orders will be followed if the self -administered prescription drug is 15
340-delivered, including situations in which the prescribing provider requires 16
341-administration under direct supervision of a medical professional for a 17
342-customarily self-administered prescription drug; 18
343- (8) Medication storage and efficacy concerns, when the 19
344-dispensing pharmacy is unable to guarantee that the enrollee will receive the 20
345-self-administered prescription drug in a timely fashion that does not 21
346-interfere with the environmental storage and transportation requirements 22
347-denoted by the manufacturer of the pharmaceutical; and 23
348- (9) Other relevant limitations, including mental health 24
349-conditions, cognitive or behavioral impairments, or any other factors that 25
350-impede or put at risk an enrollee's ability to receive, access, or administer 26
351-his or her self-administered prescription drugs. 27
352- (b)(1) An enrollee may obtain medications from a pharmacy of his or 28
353-her choice when healthcare payor affiliate services or pharmacy benefits 29
354-manager affiliate services are not suitable due to the limitations specified 30
355-under subsection (a) of this section. 31
356- (2) A healthcare payor or pharmacy benefits manager shall 32
357-facilitate access to in -person pharmacy services without imposing additional 33
358-costs or penalties on the enrollee. 34
359- (c) A healthcare payor or pharmacy benefits manager shall not mandate 35
360-the use of a healthcare payor affiliate or pharmacy benefits manager 36 As Engrossed: H3/19/25 H4/1/25 SB104
361-
362- 10 04-01-2025 14:34:50 ANS087
363-
364-
365-affiliate in cases in which use of a pharmacy benefits manager affiliate or 1
366-healthcare payor affiliate would adversely affect the enrollee's ability to 2
367-receive or administer his or her self -administered prescription drug safely 3
368-and effectively, considering the patient's individual circumstances under 4
369-subsection (a) of this section as determined by the enrollee's healthcare 5
370-provider. 6
371- (d) A healthcare payor and pharmacy benefits manager shall maintain 7
372-compliance in all dispensing practices with: 8
373- (1) The prescribing healthcare provider's orders; and 9
374- (2) All applicable federal and state laws regarding medication 10
375-dispensing and chain of custody. 11
376- (e) A healthcare payor or pharmacy benefits manager shall not 12
377-retaliate against an enrollee or healthcare provider for exercising his or 13
378-her rights under this section by: 14
379- (1) Increasing costs; 15
380- (2) Denying services; or 16
381- (3) Reporting to external agencies. 17
382- (f) A dispute arising from the enforcement of this section shall be 18
383-subject to a fair and prompt resolution process as defined by rule by the 19
384-Insurance Commissioner. 20
385- (g)(1) The commissioner may promulgate rules necessary to implement, 21
386-administer, and enforce this section. 22
387- (2) Rules that the commissioner may adopt under this section 23
388-include without limitation rules relating to: 24
389- (A) Resolving disputes that arise from enforcement of this 25
390-section through a fair and prompt resolution process; and 26
391- (B) Implementing a penalty structure for a healthcare 27
392-payor or pharmacy benefits manager that fails to comply with this section 28
393-that: 29
394- (i) Is based on the number of Arkansas residents 30
395-serviced by the healthcare payor or pharmacy benefits manager; and 31
396- (ii) Does not exceed one hundred thousand dollars 32
397-($100,000) per violation. 33
398- 34
399- 23-92-515. Self-administered prescription drug — Definition 35
400-controlling. 36 As Engrossed: H3/19/25 H4/1/25 SB104
401-
402- 11 04-01-2025 14:34:50 ANS087
403-
404-
405- (a) The definition of "self -administered prescription drug" under this 1
406-subchapter is controlling, and that defined term shall not be altered, 2
407-modified, reclassified, relabeled, or reinterpreted by a health benefit plan, 3
408-healthcare payor, healthcare payor affiliate, pharmacy benefits manager, or 4
409-pharmacy benefits manager affiliate. 5
410- (b) A classification, labeling, or interpretation by a health benefit 6
411-plan, healthcare payor, healthcare payor affiliate, pharmacy benefits 7
412-manager, or pharmacy benefits manager affiliate does not override or 8
413-supersede the definition of "self -administered prescription drug" under this 9
414-subchapter. 10
415- 11
416- 23-92-516. Violation of Deceptive Trade Practices Act —Enforcement — 12
417-Exclusions. 13
418- (a) A prohibition of an activity under this subchapter is applicable 14
419-to a person or entity that: 15
420- (1) Performs the prohibited activity; 16
421- (2) Causes another person or entity to perform the prohibited 17
422-activity; 18
423- (3) Solicits, advises, encourages, or coerces another person or 19
424-entity to perform the prohibited activity; 20
425- (4) Aids or attempts to aid another person or entity in 21
426-performing a prohibited activity; or 22
427- (5) Indirectly performs the prohibited activity. 23
428- (b)(1) This subchapter does not require a self -funded health benefit 24
429-plan to: 25
430- (A) Alter existing covered benefits of the self -funded 26
431-health benefit plan; or 27
432- (B) Modify underlying plan terms of the self -funded health 28
433-benefit plan. 29
434- (2) However, to the extent not preempted by federal law, this 30
435-section applies to the administration and business practices of pharmacy 31
436-benefits within the state, including without limitation the conduct of 32
437-pharmacy benefits managers and pharmacy benefits manager affiliates. 33
438- (c)(1) If a pharmacy benefits manager imposes or represents any 34
439-requirement or limitation as health -benefit-plan-imposed, the actual terms of 35
440-the underlying health benefit plan document shall control. 36 As Engrossed: H3/19/25 H4/1/25 SB104
441-
442- 12 04-01-2025 14:34:50 ANS087
443-
444-
445- (2) The plan sponsor shall retain the authority to interpret and 1
446-apply the health benefit plan sponsor's own health benefit plan’s terms to 2
447-the extent permitted by applicable federal and state law. 3
448- (d) If it is determined by the Insurance Commissioner that a pharmacy 4
449-benefits manager or pharmacy benefits manager affiliate is operating outside 5
450-the terms of the underlying health benefit plan, all dispute, enforcement, 6
451-and penalties under this subchapter shall apply and may be enforced by the 7
452-commissioner. 8
453- SECTION 5. EMERGENCY CLAUSE. It is found and determined by the 9
454-General Assembly of the State of Arkansas that an enrollee's access to 10
455-prescription medications is of immediate concern; that undue restrictions on 11
456-pharmacies and pharmacists hinder patient care; and that this act is 12
457-immediately necessary to protect an enrollee's rights and ensure timely 13
458-access to medications. Therefore, an emergency is declared to exist, and this 14
459-act being immediately necessary for the preservation of the public peace, 15
460-health, and safety shall become effective on: 16
461- (1) The date of its approval by the Governor; 17
462- (2) If the bill is neither approved nor vetoed by the Governor, 18
463-the expiration of the period of time during which the Governor may veto the 19
464-bill; or 20
465- (3) If the bill is vetoed by the Governor and the veto is 21
466-overridden, the date the last house overrides the veto. 22
467- 23
468-/s/C. Penzo 24
469407 25
470408 26
471-APPROVED: 4/10/25 27
409+ 27
472410 28
473411 29
474412 30
475413 31
476414 32
477415 33
478416 34
479417 35
480418 36