(a) If the Arkansas State Board of Pharmacy and the Arkansas State Medical Board, jointly, disallow a prior authorization of a prescription drug, medicine, biological product, pharmaceutical, or pharmaceutical service requested under § 23-99-1128, a healthcare insurer, pharmacy benefits manager, or other interested party may file an appeal to the State Insurance Department within ninety (90) days of the disallowance of the prior authorization.
(b) The healthcare insurer, pharmacy benefits manager, or other interested party shall provide a notice of seven (7) days to the Arkansas State Board of Pharmacy and the Arkansas State Medical Board of the healthcare insurer's, pharmacy benefits manager's, or other interested party's intent to file an appeal.
(c) No later than the thirtieth day after the date a healthcare insurer, pharmacy benefits manager, or other interested party files an appeal under subsection (a) of this section, the Insurance Commissioner shall appoint an independent review organization to review the appeal.
(d) A healthcare insurer, pharmacy benefits manager, or other interested party that files an appeal under subsection (a) of this section shall pay for the independent review organization appointed under subsection (c) of this section to review the appeal.
(e) (1) If a healthcare insurer, pharmacy benefits manager, or other interested party succeeds in its appeal and overturns the decision of the Arkansas State Board of Pharmacy and the Arkansas State Medical Board, the healthcare insurer, pharmacy benefits manager, or other interested party shall be reimbursed for fifty percent (50%) of the cost remitted to the independent review organization under subsection (d) of this section.(2) The Arkansas State Board of Pharmacy and the Arkansas State Medical Board shall each provide twenty-five percent (25%) of the total reimbursement to the healthcare insurer, pharmacy benefits manager, or other interested party under subdivision (e)(1) of this section.
(1) If a healthcare insurer, pharmacy benefits manager, or other interested party succeeds in its appeal and overturns the decision of the Arkansas State Board of Pharmacy and the Arkansas State Medical Board, the healthcare insurer, pharmacy benefits manager, or other interested party shall be reimbursed for fifty percent (50%) of the cost remitted to the independent review organization under subsection (d) of this section.
(2) The Arkansas State Board of Pharmacy and the Arkansas State Medical Board shall each provide twenty-five percent (25%) of the total reimbursement to the healthcare insurer, pharmacy benefits manager, or other interested party under subdivision (e)(1) of this section.
(f) A healthcare insurer, pharmacy benefits manager, or other interested party is bound by the independent review organization's determination of the appeal under this section.