TO PROVIDE A DRUG REIMBURSEMENT PROCESS FOR CERTAIN HEALTHCARE PROVIDERS.

Healthcare providers gain drug payment protections

Arkansas healthcare providers can appeal drug payments below their documented cost to buy the drug. Insurers and entities contracting for them must allow at least 60 business days after a claim decision to appeal. Providers can submit appeals directly to the insurer or plan, with contact options provided. The contracting entity must respond within 30 business days. A denial must explain the specific reason and identify any additional information needed to prove the drug's cost. A successful appeal requires payment of at least 110% of the provider's documented purchase cost. The entity must reprocess the disputed claim and later claims for the same drug, identified by standard drug or billing codes. The rate lasts through the current fiscal quarter when the appeal is filed before that quarter's last month. Appeals filed in the last month receive that rate through the following fiscal quarter. Providers can also send quarterly lists of drugs costing more than contracted payments. The entity can then raise payments to at least 110% of purchase cost, but this step is optional. The law covers drugs, biological products, and related medical supplies, but excludes services paid through licensed pharmacy benefits managers. It also excludes dental-only, vision-only, disability-income, credit, specified supplemental or limited-benefit, certain workers' compensation, and nonfederal governmental plans. The law does not directly change patients' copays, premiums, or benefits.