Title 20 — Insurance

In this chapter, unless the context otherwise requires: 1. "Auditing entity" means any person, company, group or plan working on behalf of or pursuant to a contract with an insurer or pharmacy benefits manager for the purposes of auditing pharmacy drug claims adjudicated by pharm…

A. The following procedures apply to an audit conducted by an auditing entity: 1. When conducting an in-pharmacy audit an auditing entity shall: (a) Give a pharmacy at least fourteen days' written notice. (b) Not conduct an audit during the first five days of the month unless the…

A. The auditing entity must deliver a preliminary audit report to the pharmacy within sixty days after the conclusion of the audit. B. A pharmacy is allowed at least thirty days after receipt of the preliminary audit to provide documentation to address any discrepancy found in th…

A. Notwithstanding any other law, this article applies only to audits conducted of pharmacies located in this state. B. This article does not apply to claims reviews that are initiated within three business days after transmission of a claim in which no chargeback or recoupment i…

A. A pharmacy benefit manager shall do all of the following: 1. Update the price and drug information for each list that the pharmacy benefit manager maintains every seven business days. 2. At the beginning of the term of a contract, on renewal of a contract and at least once ann…

1. Adjudicating a pharmacy benefit claim. 2. Processing or transmitting a pharmacy benefit claim. 3. Developing or managing a claims processing or adjudication network. 4. Participating in a claims processing or adjudication network. B. A pharmacy may submit a complaint of a viol…

B. A pharmacy benefit manager that applies for a certificate of authority shall submit to the director both of the following: 1. An application in a form and manner prescribed by the director. An officer or individual who is responsible for the conduct of the activities of the ph…

B. The director shall not order the destruction or other disposal of any record, book, document or other data that is: 1. Required by law to be maintained. 2. Kept on file with the department until ten years have passed. 3. Filed during the director's administration or administra…

A. A pharmacy benefit manager that enters into an agreement with a health care insurer to provide pharmacy benefit management services to covered individuals on behalf of the pharmacy benefit manager or a health care insurer may not limit or exclude coverage of a prescription dru…

A. On renewal of a health care plan, a health care insurer, pharmacy benefit manager or utilization review agent shall provide a covered individual and prescribing health care provider with access to a clear and convenient process to request a formulary exception process. The hea…

1. "Drug coverage": (a) Means any form of compensation paid to a pharmacy that dispenses prescription drugs for a patient under a contractual or other legal obligation with a health insurer or pharmacy benefit manager. (b) Does not include either of the following: (i) Coverage pr…

B. This article does not apply to any of the following: 1. The Arizona health care cost containment system administration and its contractors as defined in section 36-2901 to the extent the services are provided pursuant to title 36, chapter 29 or 34 or equivalent medicaid progra…

1. Discriminate in reimbursement on the basis that the pharmacy dispenses a 340B drug. 2. Assess any fee, chargeback, clawback or adjustment on the basis that a pharmacy dispenses a 340B drug. 3. Exclude a pharmacy from a third party's pharmacy network on the basis that the pharm…