(a) A pharmacy benefits manager may differentiate different health benefit plans, networks, or benefit packages with the use of a unique number or other form of identification.
(b) At the time of renewal of a pharmacy benefits manager license, a pharmacy benefits manager shall report to the Insurance Commissioner:(1) Each pharmacy claims bank identification number, pharmacy claims group number, and pharmacy claims processor control number that is used by the pharmacy benefits manager;(2) Each unique combination for pharmacy claims;(3) Each unique combination for pharmacy claims by the estimated number of covered lives in each combination by:(A) Less than five hundred (500);(B) Five hundred (500) to five thousand (5,000);(C) Five thousand (5,000) to twenty-five thousand (25,000);(D) Twenty-five thousand (25,000) to one hundred thousand (100,000); and(E) Greater than one hundred thousand (100,000); and(4) Each unique combination for pharmacy claims by plan type and network that apply to:(A) An employer-sponsored plan;(B) A fully-insured plan;(C) A self-funded plan;(D) A plan or program that is funded by a state appropriation to furnish, cover the cost of, or otherwise provide for pharmacist services;(E) A plan or program that is funded by the United States Government or covers a federal employee, including without limitation Tricare and Medicare Part D;(F) A plan that is provided to municipal or county employees;(G) A plan that is provided to the Division of Arkansas State Police;(H) A plan that is provided to an employee of a public two-year or four-year institution of higher education, including a community college or technical college;(I) A plan provided under the Medicaid provider-led organized care system;(J) A plan provided by the Arkansas Health and Opportunity for Me Program established by the Arkansas Health and Opportunity for Me Act of 2021, § 23-61-1001 et seq.; or(K) Any other plan types identified by the commissioner by rule.
(1) Each pharmacy claims bank identification number, pharmacy claims group number, and pharmacy claims processor control number that is used by the pharmacy benefits manager;
(2) Each unique combination for pharmacy claims;
(3) Each unique combination for pharmacy claims by the estimated number of covered lives in each combination by:(A) Less than five hundred (500);(B) Five hundred (500) to five thousand (5,000);(C) Five thousand (5,000) to twenty-five thousand (25,000);(D) Twenty-five thousand (25,000) to one hundred thousand (100,000); and(E) Greater than one hundred thousand (100,000); and
(A) Less than five hundred (500);
(B) Five hundred (500) to five thousand (5,000);
(C) Five thousand (5,000) to twenty-five thousand (25,000);
(D) Twenty-five thousand (25,000) to one hundred thousand (100,000); and
(E) Greater than one hundred thousand (100,000); and
(4) Each unique combination for pharmacy claims by plan type and network that apply to:(A) An employer-sponsored plan;(B) A fully-insured plan;(C) A self-funded plan;(D) A plan or program that is funded by a state appropriation to furnish, cover the cost of, or otherwise provide for pharmacist services;(E) A plan or program that is funded by the United States Government or covers a federal employee, including without limitation Tricare and Medicare Part D;(F) A plan that is provided to municipal or county employees;(G) A plan that is provided to the Division of Arkansas State Police;(H) A plan that is provided to an employee of a public two-year or four-year institution of higher education, including a community college or technical college;(I) A plan provided under the Medicaid provider-led organized care system;(J) A plan provided by the Arkansas Health and Opportunity for Me Program established by the Arkansas Health and Opportunity for Me Act of 2021, § 23-61-1001 et seq.; or(K) Any other plan types identified by the commissioner by rule.
(A) An employer-sponsored plan;
(B) A fully-insured plan;
(C) A self-funded plan;
(D) A plan or program that is funded by a state appropriation to furnish, cover the cost of, or otherwise provide for pharmacist services;
(E) A plan or program that is funded by the United States Government or covers a federal employee, including without limitation Tricare and Medicare Part D;
(F) A plan that is provided to municipal or county employees;
(G) A plan that is provided to the Division of Arkansas State Police;
(H) A plan that is provided to an employee of a public two-year or four-year institution of higher education, including a community college or technical college;
(I) A plan provided under the Medicaid provider-led organized care system;
(J) A plan provided by the Arkansas Health and Opportunity for Me Program established by the Arkansas Health and Opportunity for Me Act of 2021, § 23-61-1001 et seq.; or
(K) Any other plan types identified by the commissioner by rule.
(c) (1) A pharmacy claims bank identification number may:(A) Identify a specific pharmacy benefits manager, a specific employer, or a sponsor of a plan;(B) Be connected to a nationwide pharmacy benefits manager database used to transmit and electronically process a pharmacy claim for a pharmacist or a pharmacy for pharmacist services; and(C) (i) Be used if the pharmacy benefits manager does not use or issue a pharmacy benefit card with a magnetic stripe.(ii) A pharmacy benefits manager that uses or issues a pharmacy benefit card with a magnetic stripe may use the current recommended International Organization for Standardization and the International Electrotechnical Commission issuer identifier number for electronically processing a pharmacy claim.(2) The pharmacy claims bank identification number may be a mandatory routing number to be used in electronic pharmacy claims submitted through the National Council for Prescription Drug Programs billing standards.
(1) A pharmacy claims bank identification number may:(A) Identify a specific pharmacy benefits manager, a specific employer, or a sponsor of a plan;(B) Be connected to a nationwide pharmacy benefits manager database used to transmit and electronically process a pharmacy claim for a pharmacist or a pharmacy for pharmacist services; and(C) (i) Be used if the pharmacy benefits manager does not use or issue a pharmacy benefit card with a magnetic stripe.(ii) A pharmacy benefits manager that uses or issues a pharmacy benefit card with a magnetic stripe may use the current recommended International Organization for Standardization and the International Electrotechnical Commission issuer identifier number for electronically processing a pharmacy claim.
(A) Identify a specific pharmacy benefits manager, a specific employer, or a sponsor of a plan;
(B) Be connected to a nationwide pharmacy benefits manager database used to transmit and electronically process a pharmacy claim for a pharmacist or a pharmacy for pharmacist services; and
(C) (i) Be used if the pharmacy benefits manager does not use or issue a pharmacy benefit card with a magnetic stripe.(ii) A pharmacy benefits manager that uses or issues a pharmacy benefit card with a magnetic stripe may use the current recommended International Organization for Standardization and the International Electrotechnical Commission issuer identifier number for electronically processing a pharmacy claim.
(i) Be used if the pharmacy benefits manager does not use or issue a pharmacy benefit card with a magnetic stripe.
(ii) A pharmacy benefits manager that uses or issues a pharmacy benefit card with a magnetic stripe may use the current recommended International Organization for Standardization and the International Electrotechnical Commission issuer identifier number for electronically processing a pharmacy claim.
(2) The pharmacy claims bank identification number may be a mandatory routing number to be used in electronic pharmacy claims submitted through the National Council for Prescription Drug Programs billing standards.
(d) (1) A pharmacy claims group number may be used to process a pharmacy claim in addition to a pharmacy claims bank identification number.(2) A pharmacy claims group number is not required for submission of a clean pharmacy claim unless the pharmacy benefits manager requires the pharmacy claims group number in order to identify a network or group of covered patients that require this information for submission of a clean pharmacy claim.
(1) A pharmacy claims group number may be used to process a pharmacy claim in addition to a pharmacy claims bank identification number.
(2) A pharmacy claims group number is not required for submission of a clean pharmacy claim unless the pharmacy benefits manager requires the pharmacy claims group number in order to identify a network or group of covered patients that require this information for submission of a clean pharmacy claim.
(e) (1) A pharmacy claims processor control number may be used by a pharmacy benefits manager with an identifier that is unique to the pharmacy benefits manager's business needs.(2) A pharmacy claims processor control number is not required for submission of a clean pharmacy claim unless the pharmacy benefits manager requires the pharmacy claims processor control number in order to identify a network or group of covered patients that require this information for submission of a clean pharmacy claim.
(1) A pharmacy claims processor control number may be used by a pharmacy benefits manager with an identifier that is unique to the pharmacy benefits manager's business needs.
(2) A pharmacy claims processor control number is not required for submission of a clean pharmacy claim unless the pharmacy benefits manager requires the pharmacy claims processor control number in order to identify a network or group of covered patients that require this information for submission of a clean pharmacy claim.
(f) (1) Except as provided in subdivision (f)(2) of this section, the information or data acquired during an examination under this section is:(A) Considered nonproprietary and confidential under § 23-61-107(a)(4) and § 23-61-207; and(B) Not subject to the Freedom of Information Act of 1967, § 25-19-101 et seq.(2) Information and data reported under this section shall not be subject to subdivision (f)(1) of this section if the information and data is available or shared by the commissioner:(A) In a password-protected online database; or(B) On request of:(i) An Arkansas-licensed pharmacist or Arkansas-licensed pharmacy; or(ii) The contracted pharmacy services administrative organization of the Arkansas-licensed pharmacist or Arkansas-licensed pharmacy.
(1) Except as provided in subdivision (f)(2) of this section, the information or data acquired during an examination under this section is:(A) Considered nonproprietary and confidential under § 23-61-107(a)(4) and § 23-61-207; and(B) Not subject to the Freedom of Information Act of 1967, § 25-19-101 et seq.
(A) Considered nonproprietary and confidential under § 23-61-107(a)(4) and § 23-61-207; and
(B) Not subject to the Freedom of Information Act of 1967, § 25-19-101 et seq.
(2) Information and data reported under this section shall not be subject to subdivision (f)(1) of this section if the information and data is available or shared by the commissioner:(A) In a password-protected online database; or(B) On request of:(i) An Arkansas-licensed pharmacist or Arkansas-licensed pharmacy; or(ii) The contracted pharmacy services administrative organization of the Arkansas-licensed pharmacist or Arkansas-licensed pharmacy.
(A) In a password-protected online database; or
(B) On request of:(i) An Arkansas-licensed pharmacist or Arkansas-licensed pharmacy; or(ii) The contracted pharmacy services administrative organization of the Arkansas-licensed pharmacist or Arkansas-licensed pharmacy.
(i) An Arkansas-licensed pharmacist or Arkansas-licensed pharmacy; or
(ii) The contracted pharmacy services administrative organization of the Arkansas-licensed pharmacist or Arkansas-licensed pharmacy.