(a) (1) A healthcare payor, healthcare payor affiliate, pharmacy benefits manager, or pharmacy benefits manager affiliate shall not engage in unfair or deceptive trade practices in the administration of pharmacy benefits.(2) Unfair or deceptive trade practices under subdivision (a)(1) of this section include without limitation:(A) Requiring an enrollee to utilize a particular pharmacy benefits manager affiliate;(B) Requiring a pharmacy or pharmacist to forward or retransmit a prescription to a specific healthcare payor affiliate or pharmacy benefits manager affiliate unless the receiving healthcare payor affiliate or pharmacy benefits manager affiliate can provide verifiable documentation of the enrollee's consent to use that specific pharmacy;(C) Implementing a policy or protocol that unreasonably restricts an enrollee's choice of pharmacy within a pharmacy benefits manager network, if:(i) (a) The pharmacy meets the pharmacy benefits manager network's relevant and reasonable terms of participation requirements.(b) A disagreement or concern regarding whether relevant and reasonable terms of participation requirements are relevant and reasonable shall be determined by the Insurance Commissioner; and(ii) The pharmacy has existing approval to dispense one (1) or more self-administered prescription drugs in one (1) or more pharmacy benefits manager networks for the underlying health benefit plan;(D) (i) Providing an incentive or imposing a penalty that effectively coerces or pressures an enrollee to use a particular healthcare payor affiliate or pharmacy benefits manager affiliate.(ii) Adjustments to an enrollee's cost-sharing responsibilities, including copayments, coinsurance, or deductibles, that are part of the health benefit plan's design are not considered incentives or penalties under subdivision (a)(2)(D)(i) of this section;(E) Failing to disclose to an enrollee the options available for obtaining prescription drugs within the pharmacy benefits manager network;(F) Disclosing, sharing, or otherwise making available enrollee information or enrollee-identifiable prescription information submitted by a pharmacist or pharmacy to a healthcare payor affiliate or pharmacy benefits manager affiliate without the written consent of the enrollee;(G) Using or disclosing enrollee information or enrollee-identifiable prescription information for marketing or solicitation purposes without the written consent of the enrollee; and(H) (i) Engaging in any conduct that unlawfully restricts, limits, or interferes with an enrollee's right to choose a pharmacy or pharmacist, including without limitation actions that violate federal law or state law or improperly steer enrollees to a specific pharmacy or pharmacist.(ii) The prohibition under subdivision (a)(2)(H)(i) of this section does not apply to a change in patient cost-sharing obligations, including copayments, coinsurance, or deductibles, that are permitted under applicable law.
(1) A healthcare payor, healthcare payor affiliate, pharmacy benefits manager, or pharmacy benefits manager affiliate shall not engage in unfair or deceptive trade practices in the administration of pharmacy benefits.
(2) Unfair or deceptive trade practices under subdivision (a)(1) of this section include without limitation:(A) Requiring an enrollee to utilize a particular pharmacy benefits manager affiliate;(B) Requiring a pharmacy or pharmacist to forward or retransmit a prescription to a specific healthcare payor affiliate or pharmacy benefits manager affiliate unless the receiving healthcare payor affiliate or pharmacy benefits manager affiliate can provide verifiable documentation of the enrollee's consent to use that specific pharmacy;(C) Implementing a policy or protocol that unreasonably restricts an enrollee's choice of pharmacy within a pharmacy benefits manager network, if:(i) (a) The pharmacy meets the pharmacy benefits manager network's relevant and reasonable terms of participation requirements.(b) A disagreement or concern regarding whether relevant and reasonable terms of participation requirements are relevant and reasonable shall be determined by the Insurance Commissioner; and(ii) The pharmacy has existing approval to dispense one (1) or more self-administered prescription drugs in one (1) or more pharmacy benefits manager networks for the underlying health benefit plan;(D) (i) Providing an incentive or imposing a penalty that effectively coerces or pressures an enrollee to use a particular healthcare payor affiliate or pharmacy benefits manager affiliate.(ii) Adjustments to an enrollee's cost-sharing responsibilities, including copayments, coinsurance, or deductibles, that are part of the health benefit plan's design are not considered incentives or penalties under subdivision (a)(2)(D)(i) of this section;(E) Failing to disclose to an enrollee the options available for obtaining prescription drugs within the pharmacy benefits manager network;(F) Disclosing, sharing, or otherwise making available enrollee information or enrollee-identifiable prescription information submitted by a pharmacist or pharmacy to a healthcare payor affiliate or pharmacy benefits manager affiliate without the written consent of the enrollee;(G) Using or disclosing enrollee information or enrollee-identifiable prescription information for marketing or solicitation purposes without the written consent of the enrollee; and(H) (i) Engaging in any conduct that unlawfully restricts, limits, or interferes with an enrollee's right to choose a pharmacy or pharmacist, including without limitation actions that violate federal law or state law or improperly steer enrollees to a specific pharmacy or pharmacist.(ii) The prohibition under subdivision (a)(2)(H)(i) of this section does not apply to a change in patient cost-sharing obligations, including copayments, coinsurance, or deductibles, that are permitted under applicable law.
(A) Requiring an enrollee to utilize a particular pharmacy benefits manager affiliate;
(B) Requiring a pharmacy or pharmacist to forward or retransmit a prescription to a specific healthcare payor affiliate or pharmacy benefits manager affiliate unless the receiving healthcare payor affiliate or pharmacy benefits manager affiliate can provide verifiable documentation of the enrollee's consent to use that specific pharmacy;
(C) Implementing a policy or protocol that unreasonably restricts an enrollee's choice of pharmacy within a pharmacy benefits manager network, if:(i) (a) The pharmacy meets the pharmacy benefits manager network's relevant and reasonable terms of participation requirements.(b) A disagreement or concern regarding whether relevant and reasonable terms of participation requirements are relevant and reasonable shall be determined by the Insurance Commissioner; and(ii) The pharmacy has existing approval to dispense one (1) or more self-administered prescription drugs in one (1) or more pharmacy benefits manager networks for the underlying health benefit plan;
(i) (a) The pharmacy meets the pharmacy benefits manager network's relevant and reasonable terms of participation requirements.(b) A disagreement or concern regarding whether relevant and reasonable terms of participation requirements are relevant and reasonable shall be determined by the Insurance Commissioner; and
(a) The pharmacy meets the pharmacy benefits manager network's relevant and reasonable terms of participation requirements.
(b) A disagreement or concern regarding whether relevant and reasonable terms of participation requirements are relevant and reasonable shall be determined by the Insurance Commissioner; and
(ii) The pharmacy has existing approval to dispense one (1) or more self-administered prescription drugs in one (1) or more pharmacy benefits manager networks for the underlying health benefit plan;
(D) (i) Providing an incentive or imposing a penalty that effectively coerces or pressures an enrollee to use a particular healthcare payor affiliate or pharmacy benefits manager affiliate.(ii) Adjustments to an enrollee's cost-sharing responsibilities, including copayments, coinsurance, or deductibles, that are part of the health benefit plan's design are not considered incentives or penalties under subdivision (a)(2)(D)(i) of this section;
(i) Providing an incentive or imposing a penalty that effectively coerces or pressures an enrollee to use a particular healthcare payor affiliate or pharmacy benefits manager affiliate.
(ii) Adjustments to an enrollee's cost-sharing responsibilities, including copayments, coinsurance, or deductibles, that are part of the health benefit plan's design are not considered incentives or penalties under subdivision (a)(2)(D)(i) of this section;
(E) Failing to disclose to an enrollee the options available for obtaining prescription drugs within the pharmacy benefits manager network;
(F) Disclosing, sharing, or otherwise making available enrollee information or enrollee-identifiable prescription information submitted by a pharmacist or pharmacy to a healthcare payor affiliate or pharmacy benefits manager affiliate without the written consent of the enrollee;
(G) Using or disclosing enrollee information or enrollee-identifiable prescription information for marketing or solicitation purposes without the written consent of the enrollee; and
(H) (i) Engaging in any conduct that unlawfully restricts, limits, or interferes with an enrollee's right to choose a pharmacy or pharmacist, including without limitation actions that violate federal law or state law or improperly steer enrollees to a specific pharmacy or pharmacist.(ii) The prohibition under subdivision (a)(2)(H)(i) of this section does not apply to a change in patient cost-sharing obligations, including copayments, coinsurance, or deductibles, that are permitted under applicable law.
(i) Engaging in any conduct that unlawfully restricts, limits, or interferes with an enrollee's right to choose a pharmacy or pharmacist, including without limitation actions that violate federal law or state law or improperly steer enrollees to a specific pharmacy or pharmacist.
(ii) The prohibition under subdivision (a)(2)(H)(i) of this section does not apply to a change in patient cost-sharing obligations, including copayments, coinsurance, or deductibles, that are permitted under applicable law.
(b) (1) A healthcare payor, healthcare payor affiliate, pharmacy benefits manager, or pharmacy benefits manager affiliate shall not impose restrictive terms or conditions that limit an enrollee's or an enrollee's assigned representative's rights to seek an exception to or to appeal a coverage decision or restriction with his or her health benefit plan.(2) A healthcare payor, healthcare payor affiliate, pharmacy benefits manager, or pharmacy benefits manager affiliate shall ensure that:(A) The processes for seeking an exception and filing an appeal are clearly communicated to patients in a publicly accessible manner on its website;(B) The information necessary to utilize the processes under subdivision (b)(2)(A) of this section is presented in a manner that is understandable and not hidden or obscured; and(C) An enrollee is not hindered or obstructed from exercising the rights granted to the enrollee under the enrollee's health benefit plan.
(1) A healthcare payor, healthcare payor affiliate, pharmacy benefits manager, or pharmacy benefits manager affiliate shall not impose restrictive terms or conditions that limit an enrollee's or an enrollee's assigned representative's rights to seek an exception to or to appeal a coverage decision or restriction with his or her health benefit plan.
(2) A healthcare payor, healthcare payor affiliate, pharmacy benefits manager, or pharmacy benefits manager affiliate shall ensure that:(A) The processes for seeking an exception and filing an appeal are clearly communicated to patients in a publicly accessible manner on its website;(B) The information necessary to utilize the processes under subdivision (b)(2)(A) of this section is presented in a manner that is understandable and not hidden or obscured; and(C) An enrollee is not hindered or obstructed from exercising the rights granted to the enrollee under the enrollee's health benefit plan.
(A) The processes for seeking an exception and filing an appeal are clearly communicated to patients in a publicly accessible manner on its website;
(B) The information necessary to utilize the processes under subdivision (b)(2)(A) of this section is presented in a manner that is understandable and not hidden or obscured; and
(C) An enrollee is not hindered or obstructed from exercising the rights granted to the enrollee under the enrollee's health benefit plan.
(c) (1) A healthcare payor shall not prohibit, restrict, or impede an enrollee's or an enrollee's authorized representative's ability to:(A) Discuss the enrollee's health benefit plan, including prescription drug benefits, with the healthcare payor or its authorized representatives;(B) Obtain necessary exceptions, approvals, authorizations, or related information to access the enrollee's benefits; or(C) Appeal decisions regarding the enrollee's benefits coverage decisions as provided under the terms of the enrollee's health benefit plan.(2) The healthcare payor shall ensure that an enrollee has reasonable access to the discussions, approvals, and appeals processes regardless of the pharmacy benefits manager, affiliate, or third-party administrator selected to administer prescription benefits.(3) It is an unfair and deceptive trade practice for a healthcare payor to delegate responsibilities in a manner that obstructs, hinders, or prevents an enrollee from exercising the enrollee's rights under his or her health benefit plan.
(1) A healthcare payor shall not prohibit, restrict, or impede an enrollee's or an enrollee's authorized representative's ability to:(A) Discuss the enrollee's health benefit plan, including prescription drug benefits, with the healthcare payor or its authorized representatives;(B) Obtain necessary exceptions, approvals, authorizations, or related information to access the enrollee's benefits; or(C) Appeal decisions regarding the enrollee's benefits coverage decisions as provided under the terms of the enrollee's health benefit plan.
(A) Discuss the enrollee's health benefit plan, including prescription drug benefits, with the healthcare payor or its authorized representatives;
(B) Obtain necessary exceptions, approvals, authorizations, or related information to access the enrollee's benefits; or
(C) Appeal decisions regarding the enrollee's benefits coverage decisions as provided under the terms of the enrollee's health benefit plan.
(2) The healthcare payor shall ensure that an enrollee has reasonable access to the discussions, approvals, and appeals processes regardless of the pharmacy benefits manager, affiliate, or third-party administrator selected to administer prescription benefits.
(3) It is an unfair and deceptive trade practice for a healthcare payor to delegate responsibilities in a manner that obstructs, hinders, or prevents an enrollee from exercising the enrollee's rights under his or her health benefit plan.
(d) (1) A pharmacy benefits manager and pharmacy benefits manager affiliate shall adhere to all applicable federal and state privacy laws when communicating with an enrollee.(2) A pharmacy benefits manager and pharmacy benefits manager affiliate shall not use enrollee information for marketing purposes without the written consent of the enrollee.
(1) A pharmacy benefits manager and pharmacy benefits manager affiliate shall adhere to all applicable federal and state privacy laws when communicating with an enrollee.
(2) A pharmacy benefits manager and pharmacy benefits manager affiliate shall not use enrollee information for marketing purposes without the written consent of the enrollee.
(e) A pharmacy benefits manager and pharmacy benefits manager affiliate shall comply with the timely processing of complaints and appeals as established by rule of the commissioner.
(f) (1) The commissioner may promulgate rules necessary to implement, administer, and enforce this section.(2) Rules that the commissioner may adopt under this section include without limitation rules relating to implementing a penalty structure for a healthcare payor, healthcare payor affiliate, pharmacy benefits manager, or pharmacy benefits manager affiliate that fails to comply with this section that are based on the number of Arkansas residents serviced by the healthcare payor, healthcare payor affiliate, pharmacy benefits manager, or pharmacy benefits manager affiliate.
(1) The commissioner may promulgate rules necessary to implement, administer, and enforce this section.
(2) Rules that the commissioner may adopt under this section include without limitation rules relating to implementing a penalty structure for a healthcare payor, healthcare payor affiliate, pharmacy benefits manager, or pharmacy benefits manager affiliate that fails to comply with this section that are based on the number of Arkansas residents serviced by the healthcare payor, healthcare payor affiliate, pharmacy benefits manager, or pharmacy benefits manager affiliate.
(g) (1) A violation of this subchapter is an unfair and deceptive act or practice as defined by the Deceptive Trade Practices Act, § 4-88-101 et seq.(2) All remedies, penalties, and authority granted to the Attorney General under the Deceptive Trade Practices Act, § 4-88-101 et seq., shall be available to the Attorney General for the enforcement of this subchapter.
(1) A violation of this subchapter is an unfair and deceptive act or practice as defined by the Deceptive Trade Practices Act, § 4-88-101 et seq.
(2) All remedies, penalties, and authority granted to the Attorney General under the Deceptive Trade Practices Act, § 4-88-101 et seq., shall be available to the Attorney General for the enforcement of this subchapter.