Stricken language would be deleted from and underlined language would be added to present law.
Act 514 of the Regular Session
*ANS087* 04-01-2025 14:34:50 ANS087
State of Arkansas As Engrossed: H3/19/25 H4/1/25 1
95th General Assembly A Bill 2
Regular Session, 2025 SENATE BILL 104 3
4
By: Senators C. Penzo, M. Johnson 5
By: Representative Lundstrum 6
7
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
23
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
35
SECTION 2. Arkansas Code § 23 -92-503, concerning the definitions used 36 As Engrossed: H3/19/25 H4/1/25 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)(A) "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
(B) Whether an entity is an "affiliate" does not depend on 8
the percentage or form of ownership interest or any allocation of membership 9
or ownership between entities, but it is the existence of control or common 10
control that is the sole determinative factor; 11
(17)(A) "Carve-out network" means a subset of a pharmacy 12
benefits manager's network that: 13
(i) Is created by the pharmacy benefits manager; and 14
(ii) Limits access to a certain pharmacy or 15
pharmacist for a specific drug or category of drugs. 16
(B) "Carve-out network" includes any network that 17
restricts enrollee access to in -person pharmacy services within this state by 18
offering only limited methods of obtaining a prescription drug, including 19
mail-order only options, while presenting the appearance of a full network of 20
available pharmacies; 21
(18) "Enrollee" means an individual who is entitled to receive 22
healthcare services under the terms of a health benefit plan; 23
(19)(A) "Ghost network" means a pharmacy benefits manager 24
network that includes a pharmacy or pharmacist as a participating provider 25
when that participating provider is: 26
(i) Not accepting new patients; 27
(ii) No longer in practice; or 28
(iii) Otherwise unavailable to or restricted from 29
providing services to enrollees in this state. 30
(B) "Ghost network" includes a pharmacy network in which a 31
significant number of listed participating providers are not accessible to 32
enrollees within a reasonable time frame or geographic distance; 33
(20) "Healthcare payor affiliate" means a pharmacy or pharmacist 34
that directly or indirectly, through one (1) or more intermediaries, owns or 35
controls, is owned or controlled by, or is under common ownership or control 36 As Engrossed: H3/19/25 H4/1/25 SB104
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with a healthcare payor; and 1
(21)(A) "Self-administered prescription drug" means a 2
pharmaceutical that when prescribed does not require assistance by a third 3
party to administer and can be dispensed by a pharmacy or pharmacist to an 4
enrollee for self-administration under federal and state laws and 5
regulations. 6
(B) "Self-administered prescription drug" does not include 7
over-the-counter medications that do not require a prescription. 8
9
SECTION 3. Arkansas Code § 23 -92-506(b), concerning prohibited 10
practices under the Arkansas Pharmacy Benefits Manager Licensure Act, is 11
amended to add an additional subdivision to read as follows: 12
(9) Unless reviewed and approved by the commissioner in 13
coordination with the board, require pharmacy accreditation standards or 14
certification requirements inconsistent with, more stringent than, or in 15
addition to requirements of the board. 16
17
SECTION 4. Arkansas Code Title 23, Chapter 92, Subchapter 5, is 18
amended to add additional sections to read as follows: 19
23-92-512. Unfair and deceptive trade practices. 20
(a)(1) A healthcare payor, healthcare payor affiliate, pharmacy 21
benefits manager, or pharmacy benefits manager affiliate shall not engage in 22
unfair or deceptive trade practices in the administration of pharmacy 23
benefits. 24
(2) Unfair or deceptive trade practices under subdivision (a)(1) 25
of this section include without limitation: 26
(A) Requiring an enrollee to utilize a particular 27
pharmacy benefits manager affiliate; 28
(B) Requiring a pharmacy or pharmacist to forward or 29
retransmit a prescription to a specific healthcare payor affiliate or 30
pharmacy benefits manager affiliate unless the receiving healthcare payor 31
affiliate or pharmacy benefits manager affiliate can provide verifiable 32
documentation of the enrollee's consent to use that specific pharmacy; 33
(C) Implementing a policy or protocol that unreasonably 34
restricts an enrollee's choice of pharmacy within a pharmacy benefits manager 35
network, if: 36 As Engrossed: H3/19/25 H4/1/25 SB104
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(i)(a) The pharmacy meets the pharmacy benefits 1
manager network's relevant and reasonable terms of participation 2
requirements. 3
(b) A disagreement or concern regarding 4
whether relevant and reasonable terms of participation requirements are 5
relevant and reasonable shall be determined by the Insurance Commissioner; 6
and 7
(ii) The pharmacy has existing approval to dispense 8
one (1) or more self -administered prescription drugs in one (1) or more 9
pharmacy benefits manager networks for the underlying health benefit plan; 10
(D)(i) Providing an incentive or imposing a penalty that 11
effectively coerces or pressures an enrollee to use a particular healthcare 12
payor affiliate or pharmacy benefits manager affiliate. 13
(ii) Adjustments to an enrollee's cost -sharing 14
responsibilities, including copayments, coinsurance, or deductibles, that are 15
part of the health benefit plan's design are not considered incentives or 16
penalties under subdivision (a)(2)(D)(i) of this section; 17
(E) Failing to disclose to an enrollee the options 18
available for obtaining prescription drugs within the pharmacy benefits 19
manager network; 20
(F) Disclosing, sharing, or otherwise making available 21
enrollee information or enrollee -identifiable prescription information 22
submitted by a pharmacist or pharmacy to a healthcare payor affiliate or 23
pharmacy benefits manager affiliate without the written consent of the 24
enrollee; 25
(G) Using or disclosing enrollee information or enrollee -26
identifiable prescription information for marketing or solicitation purposes 27
without the written consent of the enrollee; and 28
(H)(i) Engaging in any conduct that unlawfully restricts, 29
limits, or interferes with an enrollee's right to choose a pharmacy or 30
pharmacist, including without limitation actions that violate federal law or 31
state law or improperly steer enrollees to a specific pharmacy or pharmacist. 32
(ii) The prohibition under subdivision (a)(2)(H)(i) 33
of this section does not apply to a change in patient cost -sharing 34
obligations, including copayments, coinsurance, or deductibles, that are 35
permitted under applicable law. 36 As Engrossed: H3/19/25 H4/1/25 SB104
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(b)(1) A healthcare payor, healthcare payor affiliate, pharmacy 1
benefits manager, or pharmacy benefits manager affiliate shall not impose 2
restrictive terms or conditions that limit an enrollee's or an enrollee’s 3
assigned representative’s rights to seek an exception to or to appeal a 4
coverage decision or restriction with his or her health benefit plan. 5
(2) A healthcare payor, healthcare payor affiliate, pharmacy 6
benefits manager, or pharmacy benefits manager affiliate shall ensure that: 7
(A) The processes for seeking an exception and filing an 8
appeal are clearly communicated to patients in a publicly accessible manner 9
on its website; 10
(B) The information necessary to utilize the processes 11
under subdivision (b)(2)(A) of this section is presented in a manner that is 12
understandable and not hidden or obscured; and 13
(C) An enrollee is not hindered or obstructed from 14
exercising the rights granted to the enrollee under the enrollee's health 15
benefit plan. 16
(c)(1) A healthcare payor shall not prohibit, restrict, or impede an 17
enrollee’s or an enrollee’s authorized representative’s ability to: 18
(A) Discuss the enrollee's health benefit plan, including 19
prescription drug benefits, with the healthcare payor or its authorized 20
representatives; 21
(B) Obtain necessary exceptions, approvals, 22
authorizations, or related information to access the enrollee's benefits; or 23
(C) Appeal decisions regarding the enrollee's benefits 24
coverage decisions as provided under the terms of the enrollee's health 25
benefit plan. 26
(2) The healthcare payor shall ensure that an enrollee has 27
reasonable access to the discussions, approvals, and appeals processes 28
regardless of the pharmacy benefits manager, affiliate, or third -party 29
administrator selected to administer prescription benefits. 30
(3) It is an unfair and deceptive trade practice for a 31
healthcare payor to delegate responsibilities in a manner that obstructs, 32
hinders, or prevents an enrollee from exercising the enrollee's rights under 33
his or her health benefit plan. 34
(d)(1) A pharmacy benefits manager and pharmacy benefits manager 35
affiliate shall adhere to all applicable federal and state privacy laws when 36 As Engrossed: H3/19/25 H4/1/25 SB104
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communicating with an enrollee. 1
(2) A pharmacy benefits manager and pharmacy benefits manager 2
affiliate shall not use enrollee information for marketing purposes without 3
the written consent of the enrollee. 4
(e) A pharmacy benefits manager and pharmacy benefits manager 5
affiliate shall comply with the timely processing of complaints and appeals 6
as established by rule of the commissioner. 7
(f)(1) The commissioner may promulgate rules necessary to implement, 8
administer, and enforce this section. 9
(2) Rules that the commissioner may adopt under this section 10
include without limitation rules relating to implementing a penalty structure 11
for a healthcare payor, healthcare payor affiliate, pharmacy benefits 12
manager, or pharmacy benefits manager affiliate that fails to comply with 13
this section that is based on the number of Arkansas residents serviced by 14
the healthcare payor, healthcare payor affiliate, pharmacy benefits manager, 15
or pharmacy benefits manager affiliate. 16
(g)(1) A violation of this subchapter is an unfair and deceptive act 17
or practice as defined by the Deceptive Trade Practices Act, § 4 -88-101 et 18
seq. 19
(2) All remedies, penalties, and authority granted to the 20
Attorney General under the Deceptive Trade Practices Act, § 4 -88-101 et seq., 21
shall be available to the Attorney General for the enforcement of this 22
subchapter. 23
24
23-92-513. Prohibition of ghost networks. 25
(a)(1) A pharmacy benefits manager shall not create, utilize, or 26
maintain a ghost network within this state. 27
(2) For purposes of this section, a network shall not be 28
considered a ghost network if the network includes at least one (1) mail -29
order pharmacy option and one (1) in -person pharmacy option that is 30
physically located in this state if both the mail -order pharmacy option and 31
the in-person pharmacy option are: 32
(A) Accepting new patients; and 33
(B) Otherwise available to an enrollee in this state. 34
(b)(1) A healthcare payor or pharmacy benefits manager shall not 35
create, utilize, or maintain a carve -out network within this state by: 36 As Engrossed: H3/19/25 H4/1/25 SB104
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(A) Limiting enrollee access to specific pharmacies or 1
pharmacists for self -administered prescription drugs when an enrollee is 2
directed to use a healthcare payor affiliate, pharmacy benefits manager 3
affiliate, or other limited option while the pharmacy benefits manager 4
network appears to offer a full range of pharmacist services; 5
(B) Failing to provide adequate access to pharmacy services for 6
all covered self-administered prescription drugs, including through a 7
licensed pharmacy physically located within this state; or 8
(C) Representing that a broad network of pharmacies or 9
pharmacists is available if, in practice, access to certain self -administered 10
prescription drugs is restricted to a carve -out network that lacks sufficient 11
in-state providers accessible to an enrollee. 12
(2) For purposes of this section, a network shall not be 13
considered a carve-out network if the network includes at least one (1) mail -14
order pharmacy option and one (1) in -person pharmacy option that is 15
physically located in this state if both the mail -order pharmacy option and 16
the in-person pharmacy option are: 17
(A) Accepting new patients; and 18
(B) Otherwise available to an enrollee in this state.19
(c) A healthcare payor or pharmacy benefits manager shall ensure that 20
its pharmacy benefits manager network of participating pharmacists and 21
pharmacies: 22
(1) Accurately reflects the availability of pharmacists and 23
pharmacies actively accepting new patients; 24
(2) Provides an enrollee with reasonable access to pharmacist 25
services within this state, including options for in -person consultations and 26
medication pickup from a licensed pharmacist or pharmacy in this state; 27
(3) Is not solely serviced by a mail -order pharmacy; and 28
(4) Is not solely serviced by a pharmacy benefits manager 29
affiliate or healthcare payor affiliate. 30
(d) A healthcare payor or pharmacy benefits manager shall: 31
(1) Regularly verify and update its pharmacy benefits manager 32
network directory to reflect the current availability of participating 33
pharmacists and pharmacies; 34
(2) Remove a pharmacist or pharmacy from its pharmacy benefits 35
manager network directory if that pharmacist or pharmacy is: 36 As Engrossed: H3/19/25 H4/1/25 SB104
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(A) Not accepting new patients; 1
(B) No longer in practice; or 2
(C) Otherwise unavailable to provide services; and 3
(3) Provide accurate and accessible information to an enrollee 4
regarding participating pharmacists and pharmacies within the pharmacy 5
benefits manager network in a publicly accessible manner on its website. 6
(e)(1) The Insurance Commissioner may promulgate rules necessary to 7
implement, administer, and enforce this section. 8
(2) Rules that the commissioner may adopt under this section 9
include without limitation rules relating to: 10
(A) Requiring a healthcare payor and pharmacy benefits 11
manager to submit periodic reports on pharmacy benefits manager network 12
adequacy and accessibility; 13
(B) Investigating a complaint regarding a ghost network 14
and taking appropriate enforcement action; and 15
(C) Implementing a penalty structure for a healthcare 16
payor or pharmacy benefits manager that fails to comply with this section 17
that: 18
(i) Is based on the number of Arkansas residents 19
serviced by the healthcare payor or pharmacy benefits manager; and 20
(ii) Does not exceed one hundred thousand dollars 21
($100,000) per violation. 22
23
23-92-514. Patient accommodation and nonrestriction clause. 24
(a) A healthcare payor or pharmacy benefits manager shall not enforce 25
the use of a particular healthcare payor affiliate or pharmacy benefits 26
manager affiliate without considering the enrollee's individual limitations, 27
including without limitation: 28
(1) Medical limitations, including chronic illnesses, temporary 29
or permanent disabilities, or conditions requiring specialized care or that 30
impair cognitive or motor functions; 31
(2) Complex therapies, when the self -administered prescription 32
drug is one (1) of multiple pharmaceuticals provided to an enrollee receiving 33
treatment and mailing the individual pharmaceutical has the potential to 34
interfere with the appropriate and timely administration requirements; 35
(3) Physical limitations, including mobility impairments or 36 As Engrossed: H3/19/25 H4/1/25 SB104
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inability to retrieve mail or other deliveries without assistance or risk for 1
physical harm to self while retrieving mail or other deliveries; 2
(4) Socioeconomic limitations, including financial hardships, 3
lack of reliable transportation, lack of a caregiver, or other socioeconomic 4
barriers that may prohibit an enrollee from being present during delivery or 5
prohibit an enrollee from accessing the delivery location; 6
(5) Housing limitations, including homelessness, medical 7
confinement, incarceration, unstable housing situations, residences without 8
secure mail delivery options, or residences with shared mail facilities; 9
(6) Chain of custody, when a dispensing pharmacy cannot 10
guarantee that the recipient of the self -administered prescription drug will 11
be present according to federal and state laws and regulations; 12
(7) Prescribing provider order contradictions, when the 13
dispensing pharmacy is unable to guarantee that the prescribing provider's 14
orders will be followed if the self -administered prescription drug is 15
delivered, including situations in which the prescribing provider requires 16
administration under direct supervision of a medical professional for a 17
customarily self-administered prescription drug; 18
(8) Medication storage and efficacy concerns, when the 19
dispensing pharmacy is unable to guarantee that the enrollee will receive the 20
self-administered prescription drug in a timely fashion that does not 21
interfere with the environmental storage and transportation requirements 22
denoted by the manufacturer of the pharmaceutical; and 23
(9) Other relevant limitations, including mental health 24
conditions, cognitive or behavioral impairments, or any other factors that 25
impede or put at risk an enrollee's ability to receive, access, or administer 26
his or her self-administered prescription drugs. 27
(b)(1) An enrollee may obtain medications from a pharmacy of his or 28
her choice when healthcare payor affiliate services or pharmacy benefits 29
manager affiliate services are not suitable due to the limitations specified 30
under subsection (a) of this section. 31
(2) A healthcare payor or pharmacy benefits manager shall 32
facilitate access to in -person pharmacy services without imposing additional 33
costs or penalties on the enrollee. 34
(c) A healthcare payor or pharmacy benefits manager shall not mandate 35
the use of a healthcare payor affiliate or pharmacy benefits manager 36 As Engrossed: H3/19/25 H4/1/25 SB104
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affiliate in cases in which use of a pharmacy benefits manager affiliate or 1
healthcare payor affiliate would adversely affect the enrollee's ability to 2
receive or administer his or her self -administered prescription drug safely 3
and effectively, considering the patient's individual circumstances under 4
subsection (a) of this section as determined by the enrollee's healthcare 5
provider. 6
(d) A healthcare payor and pharmacy benefits manager shall maintain 7
compliance in all dispensing practices with: 8
(1) The prescribing healthcare provider's orders; and 9
(2) All applicable federal and state laws regarding medication 10
dispensing and chain of custody. 11
(e) A healthcare payor or pharmacy benefits manager shall not 12
retaliate against an enrollee or healthcare provider for exercising his or 13
her rights under this section by: 14
(1) Increasing costs; 15
(2) Denying services; or 16
(3) Reporting to external agencies. 17
(f) A dispute arising from the enforcement of this section shall be 18
subject to a fair and prompt resolution process as defined by rule by the 19
Insurance Commissioner. 20
(g)(1) The commissioner may promulgate rules necessary to implement, 21
administer, and enforce this section. 22
(2) Rules that the commissioner may adopt under this section 23
include without limitation rules relating to: 24
(A) Resolving disputes that arise from enforcement of this 25
section through a fair and prompt resolution process; and 26
(B) Implementing a penalty structure for a healthcare 27
payor or pharmacy benefits manager that fails to comply with this section 28
that: 29
(i) Is based on the number of Arkansas residents 30
serviced by the healthcare payor or pharmacy benefits manager; and 31
(ii) Does not exceed one hundred thousand dollars 32
($100,000) per violation. 33
34
23-92-515. Self-administered prescription drug — Definition 35
controlling. 36 As Engrossed: H3/19/25 H4/1/25 SB104
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(a) The definition of "self -administered prescription drug" under this 1
subchapter is controlling, and that defined term shall not be altered, 2
modified, reclassified, relabeled, or reinterpreted by a health benefit plan, 3
healthcare payor, healthcare payor affiliate, pharmacy benefits manager, or 4
pharmacy benefits manager affiliate. 5
(b) A classification, labeling, or interpretation by a health benefit 6
plan, healthcare payor, healthcare payor affiliate, pharmacy benefits 7
manager, or pharmacy benefits manager affiliate does not override or 8
supersede the definition of "self -administered prescription drug" under this 9
subchapter. 10
11
23-92-516. Violation of Deceptive Trade Practices Act —Enforcement — 12
Exclusions. 13
(a) A prohibition of an activity under this subchapter is applicable 14
to a person or entity that: 15
(1) Performs the prohibited activity; 16
(2) Causes another person or entity to perform the prohibited 17
activity; 18
(3) Solicits, advises, encourages, or coerces another person or 19
entity to perform the prohibited activity; 20
(4) Aids or attempts to aid another person or entity in 21
performing a prohibited activity; or 22
(5) Indirectly performs the prohibited activity. 23
(b)(1) This subchapter does not require a self -funded health benefit 24
plan to: 25
(A) Alter existing covered benefits of the self -funded 26
health benefit plan; or 27
(B) Modify underlying plan terms of the self -funded health 28
benefit plan. 29
(2) However, to the extent not preempted by federal law, this 30
section applies to the administration and business practices of pharmacy 31
benefits within the state, including without limitation the conduct of 32
pharmacy benefits managers and pharmacy benefits manager affiliates. 33
(c)(1) If a pharmacy benefits manager imposes or represents any 34
requirement or limitation as health -benefit-plan-imposed, the actual terms of 35
the underlying health benefit plan document shall control. 36 As Engrossed: H3/19/25 H4/1/25 SB104
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(2) The plan sponsor shall retain the authority to interpret and 1
apply the health benefit plan sponsor's own health benefit plan’s terms to 2
the extent permitted by applicable federal and state law. 3
(d) If it is determined by the Insurance Commissioner that a pharmacy 4
benefits manager or pharmacy benefits manager affiliate is operating outside 5
the terms of the underlying health benefit plan, all dispute, enforcement, 6
and penalties under this subchapter shall apply and may be enforced by the 7
commissioner. 8
SECTION 5. EMERGENCY CLAUSE. It is found and determined by the 9
General Assembly of the State of Arkansas that an enrollee's access to 10
prescription medications is of immediate concern; that undue restrictions on 11
pharmacies and pharmacists hinder patient care; and that this act is 12
immediately necessary to protect an enrollee's rights and ensure timely 13
access to medications. Therefore, an emergency is declared to exist, and this 14
act being immediately necessary for the preservation of the public peace, 15
health, and safety shall become effective on: 16
(1) The date of its approval by the Governor; 17
(2) If the bill is neither approved nor vetoed by the Governor, 18
the expiration of the period of time during which the Governor may veto the 19
bill; or 20
(3) If the bill is vetoed by the Governor and the veto is 21
overridden, the date the last house overrides the veto. 22
23
/s/C. Penzo 24
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APPROVED: 4/10/25 27
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