(a) (1) A pharmacy benefits manager shall not create, utilize, or maintain a ghost network within this state.(2) For purposes of this section, a network shall not be considered a ghost network if the network includes at least one (1) mail-order pharmacy option and one (1) in-person pharmacy option that is physically located in this state if both the mail-order pharmacy option and the in-person pharmacy option are:(A) Accepting new patients; and(B) Otherwise available to an enrollee in this state.
(1) A pharmacy benefits manager shall not create, utilize, or maintain a ghost network within this state.
(2) For purposes of this section, a network shall not be considered a ghost network if the network includes at least one (1) mail-order pharmacy option and one (1) in-person pharmacy option that is physically located in this state if both the mail-order pharmacy option and the in-person pharmacy option are:(A) Accepting new patients; and(B) Otherwise available to an enrollee in this state.
(A) Accepting new patients; and
(B) Otherwise available to an enrollee in this state.
(b) (1) A healthcare payor or pharmacy benefits manager shall not create, utilize, or maintain a carve-out network within this state by:(A) Limiting enrollee access to specific pharmacies or pharmacists for self-administered prescription drugs when an enrollee is directed to use a healthcare payor affiliate, pharmacy benefits manager affiliate, or other limited option while the pharmacy benefits manager network appears to offer a full range of pharmacist services;(B) Failing to provide adequate access to pharmacy services for all covered self-administered prescription drugs, including through a licensed pharmacy physically located within this state; or(C) Representing that a broad network of pharmacies or pharmacists is available if, in practice, access to certain self-administered prescription drugs is restricted to a carve-out network that lacks sufficient in-state providers accessible to an enrollee.(2) For purposes of this section, a network shall not be considered a carve-out network if the network includes at least one (1) mail-order pharmacy option and one (1) in-person pharmacy option that is physically located in this state if both the mail-order pharmacy option and the in-person pharmacy option are:(A) Accepting new patients; and(B) Otherwise available to an enrollee in this state.
(1) A healthcare payor or pharmacy benefits manager shall not create, utilize, or maintain a carve-out network within this state by:(A) Limiting enrollee access to specific pharmacies or pharmacists for self-administered prescription drugs when an enrollee is directed to use a healthcare payor affiliate, pharmacy benefits manager affiliate, or other limited option while the pharmacy benefits manager network appears to offer a full range of pharmacist services;(B) Failing to provide adequate access to pharmacy services for all covered self-administered prescription drugs, including through a licensed pharmacy physically located within this state; or(C) Representing that a broad network of pharmacies or pharmacists is available if, in practice, access to certain self-administered prescription drugs is restricted to a carve-out network that lacks sufficient in-state providers accessible to an enrollee.
(A) Limiting enrollee access to specific pharmacies or pharmacists for self-administered prescription drugs when an enrollee is directed to use a healthcare payor affiliate, pharmacy benefits manager affiliate, or other limited option while the pharmacy benefits manager network appears to offer a full range of pharmacist services;
(B) Failing to provide adequate access to pharmacy services for all covered self-administered prescription drugs, including through a licensed pharmacy physically located within this state; or
(C) Representing that a broad network of pharmacies or pharmacists is available if, in practice, access to certain self-administered prescription drugs is restricted to a carve-out network that lacks sufficient in-state providers accessible to an enrollee.
(2) For purposes of this section, a network shall not be considered a carve-out network if the network includes at least one (1) mail-order pharmacy option and one (1) in-person pharmacy option that is physically located in this state if both the mail-order pharmacy option and the in-person pharmacy option are:(A) Accepting new patients; and(B) Otherwise available to an enrollee in this state.
(A) Accepting new patients; and
(B) Otherwise available to an enrollee in this state.
(c) A healthcare payor or pharmacy benefits manager shall ensure that its pharmacy benefits manager network of participating pharmacists and pharmacies:(1) Accurately reflects the availability of pharmacists and pharmacies actively accepting new patients;(2) Provides an enrollee with reasonable access to pharmacist services within this state, including options for in-person consultations and medication pickup from a licensed pharmacist or pharmacy in this state;(3) Is not solely serviced by a mail-order pharmacy; and(4) Is not solely serviced by a pharmacy benefits manager affiliate or healthcare payor affiliate.
(1) Accurately reflects the availability of pharmacists and pharmacies actively accepting new patients;
(2) Provides an enrollee with reasonable access to pharmacist services within this state, including options for in-person consultations and medication pickup from a licensed pharmacist or pharmacy in this state;
(3) Is not solely serviced by a mail-order pharmacy; and
(4) Is not solely serviced by a pharmacy benefits manager affiliate or healthcare payor affiliate.
(d) A healthcare payor or pharmacy benefits manager shall:(1) Regularly verify and update its pharmacy benefits manager network directory to reflect the current availability of participating pharmacists and pharmacies;(2) Remove a pharmacist or pharmacy from its pharmacy benefits manager network directory if that pharmacist or pharmacy is:(A) Not accepting new patients;(B) No longer in practice; or(C) Otherwise unavailable to provide services; and(3) Provide accurate and accessible information to an enrollee regarding participating pharmacists and pharmacies within the pharmacy benefits manager network in a publicly accessible manner on its website.
(1) Regularly verify and update its pharmacy benefits manager network directory to reflect the current availability of participating pharmacists and pharmacies;
(2) Remove a pharmacist or pharmacy from its pharmacy benefits manager network directory if that pharmacist or pharmacy is:(A) Not accepting new patients;(B) No longer in practice; or(C) Otherwise unavailable to provide services; and
(A) Not accepting new patients;
(B) No longer in practice; or
(C) Otherwise unavailable to provide services; and
(3) Provide accurate and accessible information to an enrollee regarding participating pharmacists and pharmacies within the pharmacy benefits manager network in a publicly accessible manner on its website.
(e) (1) The Insurance 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:(A) Requiring a healthcare payor and pharmacy benefits manager to submit periodic reports on pharmacy benefits manager network adequacy and accessibility;(B) Investigating a complaint regarding a ghost network and taking appropriate enforcement action; and(C) Implementing a penalty structure for a healthcare payor or pharmacy benefits manager that fails to comply with this section that:(i) Is based on the number of Arkansas residents serviced by the healthcare payor or pharmacy benefits manager; and(ii) Does not exceed one hundred thousand dollars ($100,000) per violation.
(1) The Insurance 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:(A) Requiring a healthcare payor and pharmacy benefits manager to submit periodic reports on pharmacy benefits manager network adequacy and accessibility;(B) Investigating a complaint regarding a ghost network and taking appropriate enforcement action; and(C) Implementing a penalty structure for a healthcare payor or pharmacy benefits manager that fails to comply with this section that:(i) Is based on the number of Arkansas residents serviced by the healthcare payor or pharmacy benefits manager; and(ii) Does not exceed one hundred thousand dollars ($100,000) per violation.
(A) Requiring a healthcare payor and pharmacy benefits manager to submit periodic reports on pharmacy benefits manager network adequacy and accessibility;
(B) Investigating a complaint regarding a ghost network and taking appropriate enforcement action; and
(C) Implementing a penalty structure for a healthcare payor or pharmacy benefits manager that fails to comply with this section that:(i) Is based on the number of Arkansas residents serviced by the healthcare payor or pharmacy benefits manager; and(ii) Does not exceed one hundred thousand dollars ($100,000) per violation.
(i) Is based on the number of Arkansas residents serviced by the healthcare payor or pharmacy benefits manager; and
(ii) Does not exceed one hundred thousand dollars ($100,000) per violation.