Arizona 2025 Regular Session

Arizona House Bill HB2208 Compare Versions

Only one version of the bill is available at this time.

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1	1	REFERENCE TITLE: pharmacists; pharmacies; reimbursement costs; appeals State of Arizona House of Representatives Fifty-seventh Legislature First Regular Session 2025 HB 2208 Introduced by Representative Bliss AN ACT amending title 20, chapter 25, article 2, arizona revised statutes, by adding section 20-3335; relating to pharmacy benefit managers. (TEXT OF BILL BEGINS ON NEXT PAGE)
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9	9	REFERENCE TITLE: pharmacists; pharmacies; reimbursement costs; appeals
10	10	State of Arizona House of Representatives Fifty-seventh Legislature First Regular Session 2025
11	11	HB 2208
12	12	Introduced by Representative Bliss
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14	14	REFERENCE TITLE: pharmacists; pharmacies; reimbursement costs; appeals
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24	24	State of Arizona
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40	40	HB 2208
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44	44	Introduced by
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64	64	AN ACT
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68	68	amending title 20, chapter 25, article 2, arizona revised statutes, by adding section 20-3335; relating to pharmacy benefit managers.
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74	74	(TEXT OF BILL BEGINS ON NEXT PAGE)
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78	78	Be it enacted by the Legislature of the State of Arizona: Section 1. Title 20, chapter 25, article 2, Arizona Revised Statutes, is amended by adding section 20-3335, to read: START_STATUTE20-3335. Pharmacy benefit managers; prescription drugs or devices; reimbursement costs; appeals; procedures; exception; definitions A. A pharmacy benefit manager may not reimburse a pharmacist or pharmacy that is under contract with the pharmacy benefit manager for a prescription drug or device in an amount that is less than the actual cost paid by the pharmacist or pharmacy. B. Subsection A of this section does not apply to a pharmacy benefit manager that uses ingredient cost reimbursement methodology for a prescription drug or device that is identical to the fee-for-service methodology that is used in the state plan for medical assistance as approved by the centers for medicare and medicaid services. C. A pharmacy benefit manager may not include a professional dispensing fee in the amount that is calculated to reimburse a pharmacy for a prescription drug or device to satisfy the requirements of subsection A of this section. D. A pharmacy benefit manager shall pay a professional dispensing fee at a rate not less than the fee-for-service methodology used in the state plan for medical assistance as approved by the centers for medicare and medicaid services. E. A pharmacy benefit manager shall include in the contract with each pharmacist or pharmacy a procedure that outlines how a pharmacist or pharmacy may appeal a reimbursement rate that allegedly does not comply with subsection A of this section. A pharmacist or pharmacy shall file an appeal within seven business days after the date on which the pharmacist or pharmacy was reimbursed for a prescription drug or device. F. A pharmacy benefit manager shall file its appeal procedures with the department on a form and in a manner prescribed by the department. The department shall approve or deny a pharmacy benefit manager's appeal procedure. The appeal procedure shall include a provision that allows an agent of a pharmacist or pharmacy to submit an appeal on behalf of the pharmacist or pharmacy. A pharmacist or pharmacy may designate a pharmacy services administrative organization or other agent to file and conduct the appeal. G. If a pharmacist or pharmacy prevails in an appeal of a reimbursement cost under this section, the pharmacy benefit manager shall complete all of the following not later than seven business days after the date the pharmacist or pharmacy prevailed on appeal: 1. Make the necessary change to the challenged reimbursement or actual cost. 2. Provide the pharmacist or pharmacy with the national drug code number for a prescription drug, if the appeal was based on a prescription drug. 3. Allow the pharmacist or pharmacy to reverse and rebill the claim. 4. Reimburse the pharmacist's or pharmacy's actual cost for the prescription drug or device. 5. Apply the findings of the appeal to the reimbursement rate and actual cost for the prescription drug or device to other similarly situated pharmacists and pharmacies. H. If a pharmacy benefit manager prevails in an appeal of a reimbursement cost under this section and the prescription drug or device that is the subject of the appeal is available at a cost that is equal to or less than the challenged reimbursement cost, the pharmacy benefit manager shall provide to the pharmacist or pharmacy both of the following not later than seven business days after the pharmacy benefit manager prevailed on appeal: 1. The name of the national or regional pharmaceutical wholesaler that does business in this state and that has the prescription drug or device in stock at a price that is equal to or less than the challenged reimbursement cost. 2. The national drug code number for the prescription drug or the unique identifier for the device, as applicable. I. If the pharmacy benefit manager does not comply with subsection A of this section, the pharmacy benefit manager shall: 1. Adjust the challenged reimbursement cost to an amount that is equal to or greater than the pharmacist's or pharmacy's actual cost. 2. Allow the pharmacist or pharmacy to reverse and rebill each claim that is affected by the inability to obtain the prescription drug or device at a cost that is equal to or less than the challenged reimbursement. J. This SECTION does not apply to health and accident insurance coverage that is procured by the department of administration pursuant to section 38-651. K. For the purposes of this section: 1. "Similarly situated pharmacists or pharmacies" means pharmacists or pharmacies that met all of the following: (a) Are under contract with a pharmacy benefit manager. (b) Purchase a prescription drug or device that is the subject of an appeal of a reimbursement cost that allegedly does not comply with subsection A of this section from the same pharmaceutical wholesaler as the pharmacist or pharmacy that prevailed in the appeal. (c) To whom the pharmacy benefit manager applies the challenged reimbursement rate or actual cost for the prescription drug or device. 2. "State plan" means the Arizona health care cost containment system. END_STATUTE Sec. 2. Applicability Section 20-3335, Arizona Revised Statutes, as added by this act, applies to contracts that are entered into, amended, extended or renewed on or after December 31, 2025.
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80	80	Be it enacted by the Legislature of the State of Arizona:
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82	82	Section 1. Title 20, chapter 25, article 2, Arizona Revised Statutes, is amended by adding section 20-3335, to read:
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84	84	START_STATUTE20-3335. Pharmacy benefit managers; prescription drugs or devices; reimbursement costs; appeals; procedures; exception; definitions
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86	86	A. A pharmacy benefit manager may not reimburse a pharmacist or pharmacy that is under contract with the pharmacy benefit manager for a prescription drug or device in an amount that is less than the actual cost paid by the pharmacist or pharmacy.
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88	88	B. Subsection A of this section does not apply to a pharmacy benefit manager that uses ingredient cost reimbursement methodology for a prescription drug or device that is identical to the fee-for-service methodology that is used in the state plan for medical assistance as approved by the centers for medicare and medicaid services.
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90	90	C. A pharmacy benefit manager may not include a professional dispensing fee in the amount that is calculated to reimburse a pharmacy for a prescription drug or device to satisfy the requirements of subsection A of this section.
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92	92	D. A pharmacy benefit manager shall pay a professional dispensing fee at a rate not less than the fee-for-service methodology used in the state plan for medical assistance as approved by the centers for medicare and medicaid services.
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94	94	E. A pharmacy benefit manager shall include in the contract with each pharmacist or pharmacy a procedure that outlines how a pharmacist or pharmacy may appeal a reimbursement rate that allegedly does not comply with subsection A of this section. A pharmacist or pharmacy shall file an appeal within seven business days after the date on which the pharmacist or pharmacy was reimbursed for a prescription drug or device.
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96	96	F. A pharmacy benefit manager shall file its appeal procedures with the department on a form and in a manner prescribed by the department. The department shall approve or deny a pharmacy benefit manager's appeal procedure. The appeal procedure shall include a provision that allows an agent of a pharmacist or pharmacy to submit an appeal on behalf of the pharmacist or pharmacy. A pharmacist or pharmacy may designate a pharmacy services administrative organization or other agent to file and conduct the appeal.
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98	98	G. If a pharmacist or pharmacy prevails in an appeal of a reimbursement cost under this section, the pharmacy benefit manager shall complete all of the following not later than seven business days after the date the pharmacist or pharmacy prevailed on appeal:
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100	100	1. Make the necessary change to the challenged reimbursement or actual cost.
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102	102	2. Provide the pharmacist or pharmacy with the national drug code number for a prescription drug, if the appeal was based on a prescription drug.
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104	104	3. Allow the pharmacist or pharmacy to reverse and rebill the claim.
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106	106	4. Reimburse the pharmacist's or pharmacy's actual cost for the prescription drug or device.
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108	108	5. Apply the findings of the appeal to the reimbursement rate and actual cost for the prescription drug or device to other similarly situated pharmacists and pharmacies.
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110	110	H. If a pharmacy benefit manager prevails in an appeal of a reimbursement cost under this section and the prescription drug or device that is the subject of the appeal is available at a cost that is equal to or less than the challenged reimbursement cost, the pharmacy benefit manager shall provide to the pharmacist or pharmacy both of the following not later than seven business days after the pharmacy benefit manager prevailed on appeal:
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112	112	1. The name of the national or regional pharmaceutical wholesaler that does business in this state and that has the prescription drug or device in stock at a price that is equal to or less than the challenged reimbursement cost.
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114	114	2. The national drug code number for the prescription drug or the unique identifier for the device, as applicable.
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116	116	I. If the pharmacy benefit manager does not comply with subsection A of this section, the pharmacy benefit manager shall:
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118	118	1. Adjust the challenged reimbursement cost to an amount that is equal to or greater than the pharmacist's or pharmacy's actual cost.
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120	120	2. Allow the pharmacist or pharmacy to reverse and rebill each claim that is affected by the inability to obtain the prescription drug or device at a cost that is equal to or less than the challenged reimbursement.
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122	122	J. This SECTION does not apply to health and accident insurance coverage that is procured by the department of administration pursuant to section 38-651.
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124	124	K. For the purposes of this section:
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126	126	1. "Similarly situated pharmacists or pharmacies" means pharmacists or pharmacies that met all of the following:
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128	128	(a) Are under contract with a pharmacy benefit manager.
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130	130	(b) Purchase a prescription drug or device that is the subject of an appeal of a reimbursement cost that allegedly does not comply with subsection A of this section from the same pharmaceutical wholesaler as the pharmacist or pharmacy that prevailed in the appeal.
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132	132	(c) To whom the pharmacy benefit manager applies the challenged reimbursement rate or actual cost for the prescription drug or device.
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134	134	2. "State plan" means the Arizona health care cost containment system. END_STATUTE
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136	136	Sec. 2. Applicability
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138	138	Section 20-3335, Arizona Revised Statutes, as added by this act, applies to contracts that are entered into, amended, extended or renewed on or after December 31, 2025.