(a) A healthcare payor or pharmacy benefits manager shall not enforce the use of a particular healthcare payor affiliate or pharmacy benefits manager affiliate without considering the enrollee's individual limitations, including without limitation:(1) Medical limitations, including chronic illnesses, temporary or permanent disabilities, or conditions requiring specialized care or that impair cognitive or motor functions;(2) Complex therapies, when the self-administered prescription drug is one (1) of multiple pharmaceuticals provided to an enrollee receiving treatment and mailing the individual pharmaceutical has the potential to interfere with the appropriate and timely administration requirements;(3) Physical limitations, including mobility impairments or inability to retrieve mail or other deliveries without assistance or risk for physical harm to self while retrieving mail or other deliveries;(4) Socioeconomic limitations, including financial hardships, lack of reliable transportation, lack of a caregiver, or other socioeconomic barriers that may prohibit an enrollee from being present during delivery or prohibit an enrollee from accessing the delivery location;(5) Housing limitations, including homelessness, medical confinement, incarceration, unstable housing situations, residences without secure mail delivery options, or residences with shared mail facilities;(6) Chain of custody, when a dispensing pharmacy cannot guarantee that the recipient of the self-administered prescription drug will be present according to federal and state laws and regulations;(7) Prescribing provider order contradictions, when the dispensing pharmacy is unable to guarantee that the prescribing provider's orders will be followed if the self-administered prescription drug is delivered, including situations in which the prescribing provider requires administration under direct supervision of a medical professional for a customarily self-administered prescription drug;(8) Medication storage and efficacy concerns, when the dispensing pharmacy is unable to guarantee that the enrollee will receive the self-administered prescription drug in a timely fashion that does not interfere with the environmental storage and transportation requirements denoted by the manufacturer of the pharmaceutical; and(9) Other relevant limitations, including mental health conditions, cognitive or behavioral impairments, or any other factors that impede or put at risk an enrollee's ability to receive, access, or administer his or her self-administered prescription drugs.
(1) Medical limitations, including chronic illnesses, temporary or permanent disabilities, or conditions requiring specialized care or that impair cognitive or motor functions;
(2) Complex therapies, when the self-administered prescription drug is one (1) of multiple pharmaceuticals provided to an enrollee receiving treatment and mailing the individual pharmaceutical has the potential to interfere with the appropriate and timely administration requirements;
(3) Physical limitations, including mobility impairments or inability to retrieve mail or other deliveries without assistance or risk for physical harm to self while retrieving mail or other deliveries;
(4) Socioeconomic limitations, including financial hardships, lack of reliable transportation, lack of a caregiver, or other socioeconomic barriers that may prohibit an enrollee from being present during delivery or prohibit an enrollee from accessing the delivery location;
(5) Housing limitations, including homelessness, medical confinement, incarceration, unstable housing situations, residences without secure mail delivery options, or residences with shared mail facilities;
(6) Chain of custody, when a dispensing pharmacy cannot guarantee that the recipient of the self-administered prescription drug will be present according to federal and state laws and regulations;
(7) Prescribing provider order contradictions, when the dispensing pharmacy is unable to guarantee that the prescribing provider's orders will be followed if the self-administered prescription drug is delivered, including situations in which the prescribing provider requires administration under direct supervision of a medical professional for a customarily self-administered prescription drug;
(8) Medication storage and efficacy concerns, when the dispensing pharmacy is unable to guarantee that the enrollee will receive the self-administered prescription drug in a timely fashion that does not interfere with the environmental storage and transportation requirements denoted by the manufacturer of the pharmaceutical; and
(9) Other relevant limitations, including mental health conditions, cognitive or behavioral impairments, or any other factors that impede or put at risk an enrollee's ability to receive, access, or administer his or her self-administered prescription drugs.
(b) (1) An enrollee may obtain medications from a pharmacy of his or her choice when healthcare payor affiliate services or pharmacy benefits manager affiliate services are not suitable due to the limitations specified under subsection (a) of this section.(2) A healthcare payor or pharmacy benefits manager shall facilitate access to in-person pharmacy services without imposing additional costs or penalties on the enrollee.
(1) An enrollee may obtain medications from a pharmacy of his or her choice when healthcare payor affiliate services or pharmacy benefits manager affiliate services are not suitable due to the limitations specified under subsection (a) of this section.
(2) A healthcare payor or pharmacy benefits manager shall facilitate access to in-person pharmacy services without imposing additional costs or penalties on the enrollee.
(c) A healthcare payor or pharmacy benefits manager shall not mandate the use of a healthcare payor affiliate or pharmacy benefits manager affiliate in cases in which use of a pharmacy benefits manager affiliate or healthcare payor affiliate would adversely affect the enrollee's ability to receive or administer his or her self-administered prescription drug safely and effectively, considering the patient's individual circumstances under subsection (a) of this section as determined by the enrollee's healthcare provider.
(d) A healthcare payor and pharmacy benefits manager shall maintain compliance in all dispensing practices with:(1) The prescribing healthcare provider's orders; and(2) All applicable federal and state laws regarding medication dispensing and chain of custody.
(1) The prescribing healthcare provider's orders; and
(2) All applicable federal and state laws regarding medication dispensing and chain of custody.
(e) A healthcare payor or pharmacy benefits manager shall not retaliate against an enrollee or healthcare provider for exercising his or her rights under this section by:(1) Increasing costs;(2) Denying services; or(3) Reporting to external agencies.
(1) Increasing costs;
(2) Denying services; or
(3) Reporting to external agencies.
(f) A dispute arising from the enforcement of this section shall be subject to a fair and prompt resolution process as defined by rule by the Insurance Commissioner.
(g) (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:(A) Resolving disputes that arise from enforcement of this section through a fair and prompt resolution process; and(B) 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 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) Resolving disputes that arise from enforcement of this section through a fair and prompt resolution process; and(B) 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) Resolving disputes that arise from enforcement of this section through a fair and prompt resolution process; and
(B) 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.