(a) As used in this section:(1) “Pharmacist” means an individual licensed as a pharmacist by the Arkansas State Board of Pharmacy;(2) “Pharmacy” means the place licensed by the board in which drugs, chemicals, medicines, prescriptions, and poisons are compounded, dispensed, or sold at retail;(3) “Pharmacy benefits manager” means a person, business, or entity, including a wholly or partially owned or controlled subsidiary of a pharmacy benefits manager, that:(A) Provides claims processing services or other prescription drug or devices services, or both, for health benefit plans; and(B) Is licensed under the Arkansas Pharmacy Benefits Manager Licensure Act, § 23-92-501 et seq.;(4) (A) “Pharmacy benefits manager network” means any network of pharmacists or pharmacies that are offered by an agreement or insurance contract to provide pharmacist services for health benefit plans.(B) “Pharmacy benefits manager network” includes any network delegated by the healthcare payor to the pharmacy benefits manager; and(5) “Relevant and reasonable terms of participation” means terms and conditions that:(A) Are consistent with applicable state and federal law;(B) Are consistent with industry standards; and(C) Do not arbitrarily or discriminatorily exclude a qualified pharmacy or pharmacist.
(1) “Pharmacist” means an individual licensed as a pharmacist by the Arkansas State Board of Pharmacy;
(2) “Pharmacy” means the place licensed by the board in which drugs, chemicals, medicines, prescriptions, and poisons are compounded, dispensed, or sold at retail;
(3) “Pharmacy benefits manager” means a person, business, or entity, including a wholly or partially owned or controlled subsidiary of a pharmacy benefits manager, that:(A) Provides claims processing services or other prescription drug or devices services, or both, for health benefit plans; and(B) Is licensed under the Arkansas Pharmacy Benefits Manager Licensure Act, § 23-92-501 et seq.;
(A) Provides claims processing services or other prescription drug or devices services, or both, for health benefit plans; and
(B) Is licensed under the Arkansas Pharmacy Benefits Manager Licensure Act, § 23-92-501 et seq.;
(4) (A) “Pharmacy benefits manager network” means any network of pharmacists or pharmacies that are offered by an agreement or insurance contract to provide pharmacist services for health benefit plans.(B) “Pharmacy benefits manager network” includes any network delegated by the healthcare payor to the pharmacy benefits manager; and
(A) “Pharmacy benefits manager network” means any network of pharmacists or pharmacies that are offered by an agreement or insurance contract to provide pharmacist services for health benefit plans.
(B) “Pharmacy benefits manager network” includes any network delegated by the healthcare payor to the pharmacy benefits manager; and
(5) “Relevant and reasonable terms of participation” means terms and conditions that:(A) Are consistent with applicable state and federal law;(B) Are consistent with industry standards; and(C) Do not arbitrarily or discriminatorily exclude a qualified pharmacy or pharmacist.
(A) Are consistent with applicable state and federal law;
(B) Are consistent with industry standards; and
(C) Do not arbitrarily or discriminatorily exclude a qualified pharmacy or pharmacist.
(b) (1) A pharmacy benefits manager shall not deny a pharmacy or pharmacist the opportunity to participate in the pharmacy benefits manager's pharmacy benefits manager network if the pharmacy or pharmacist:(A) Is licensed under the laws of this state; and(B) Agrees to accept and comply with the relevant and reasonable terms of participation as determined under this section.(2) A pharmacy benefits manager shall not exclude a pharmacy or pharmacist from continued participation in the pharmacy benefits manager's pharmacy benefits manager network if the pharmacy or pharmacist continues to:(A) Be licensed under the laws of this state; and(B) Accept and comply with the relevant and reasonable terms of participation as determined under this section.(3) A pharmacy benefits manager shall not:(A) Condition participation of a pharmacy or pharmacist in one (1) pharmacy benefits manager network based on participation in any other pharmacy benefits manager network or penalize a pharmacy or pharmacist for exercising his, her, or its prerogative not to participate in a specific pharmacy benefits manager network; or(B) Limit a pharmacy benefits manager network to include solely:(i) An affiliated pharmacy; or(ii) An internet pharmacy or a pharmacy that does not have a physical presence in this state for consumer access.
(1) A pharmacy benefits manager shall not deny a pharmacy or pharmacist the opportunity to participate in the pharmacy benefits manager's pharmacy benefits manager network if the pharmacy or pharmacist:(A) Is licensed under the laws of this state; and(B) Agrees to accept and comply with the relevant and reasonable terms of participation as determined under this section.
(A) Is licensed under the laws of this state; and
(B) Agrees to accept and comply with the relevant and reasonable terms of participation as determined under this section.
(2) A pharmacy benefits manager shall not exclude a pharmacy or pharmacist from continued participation in the pharmacy benefits manager's pharmacy benefits manager network if the pharmacy or pharmacist continues to:(A) Be licensed under the laws of this state; and(B) Accept and comply with the relevant and reasonable terms of participation as determined under this section.
(A) Be licensed under the laws of this state; and
(B) Accept and comply with the relevant and reasonable terms of participation as determined under this section.
(3) A pharmacy benefits manager shall not:(A) Condition participation of a pharmacy or pharmacist in one (1) pharmacy benefits manager network based on participation in any other pharmacy benefits manager network or penalize a pharmacy or pharmacist for exercising his, her, or its prerogative not to participate in a specific pharmacy benefits manager network; or(B) Limit a pharmacy benefits manager network to include solely:(i) An affiliated pharmacy; or(ii) An internet pharmacy or a pharmacy that does not have a physical presence in this state for consumer access.
(A) Condition participation of a pharmacy or pharmacist in one (1) pharmacy benefits manager network based on participation in any other pharmacy benefits manager network or penalize a pharmacy or pharmacist for exercising his, her, or its prerogative not to participate in a specific pharmacy benefits manager network; or
(B) Limit a pharmacy benefits manager network to include solely:(i) An affiliated pharmacy; or(ii) An internet pharmacy or a pharmacy that does not have a physical presence in this state for consumer access.
(i) An affiliated pharmacy; or
(ii) An internet pharmacy or a pharmacy that does not have a physical presence in this state for consumer access.
(c) (1) If a pharmacy or pharmacist alleges that a pharmacy benefits manager has denied or excluded the pharmacy or pharmacist from participation in the pharmacy benefits manager's pharmacy benefits manager network without justification, the pharmacy or pharmacist may submit a written complaint to the Insurance Commissioner.(2) If a dispute arises as to whether there are “relevant and reasonable terms of participation” as that term is defined in this section, the commissioner shall decide the issue by determining whether the terms or conditions:(A) Are consistent with applicable state and federal law;(B) Are consistent with industry standards; and(C) Do not arbitrarily or discriminatorily exclude a qualified pharmacy or pharmacist.(3) Within thirty (30) days of receipt of the complaint under subdivision (c)(1) of this section, the commissioner, after a hearing conducted under § 23-61-301 and consideration of evidence from all parties, shall issue a determination.(4) The determination of the commissioner under subdivision (c)(3) of this section is binding on all parties, subject to judicial review under § 23-61-307.
(1) If a pharmacy or pharmacist alleges that a pharmacy benefits manager has denied or excluded the pharmacy or pharmacist from participation in the pharmacy benefits manager's pharmacy benefits manager network without justification, the pharmacy or pharmacist may submit a written complaint to the Insurance Commissioner.
(2) If a dispute arises as to whether there are “relevant and reasonable terms of participation” as that term is defined in this section, the commissioner shall decide the issue by determining whether the terms or conditions:(A) Are consistent with applicable state and federal law;(B) Are consistent with industry standards; and(C) Do not arbitrarily or discriminatorily exclude a qualified pharmacy or pharmacist.
(A) Are consistent with applicable state and federal law;
(B) Are consistent with industry standards; and
(C) Do not arbitrarily or discriminatorily exclude a qualified pharmacy or pharmacist.
(3) Within thirty (30) days of receipt of the complaint under subdivision (c)(1) of this section, the commissioner, after a hearing conducted under § 23-61-301 and consideration of evidence from all parties, shall issue a determination.
(4) The determination of the commissioner under subdivision (c)(3) of this section is binding on all parties, subject to judicial review under § 23-61-307.
(d) A pharmacy benefits manager shall not:(1) Impose terms or conditions that do not meet the definition of “relevant and reasonable terms of participation” under this section;(2) Utilize reimbursement methodologies or contractual clauses intended to indirectly exclude a willing pharmacy or pharmacist from participation; or(3) Engage in a practice that discriminates against a pharmacy or pharmacist based on the pharmacy's or pharmacist's geographic location, size, or ownership structure, unless the geographic location, size, or ownership structure is directly relevant to patient care or network adequacy.
(1) Impose terms or conditions that do not meet the definition of “relevant and reasonable terms of participation” under this section;
(2) Utilize reimbursement methodologies or contractual clauses intended to indirectly exclude a willing pharmacy or pharmacist from participation; or
(3) Engage in a practice that discriminates against a pharmacy or pharmacist based on the pharmacy's or pharmacist's geographic location, size, or ownership structure, unless the geographic location, size, or ownership structure is directly relevant to patient care or network adequacy.
(e) This section does not:(1) Regulate the design or administration of employee benefit plans; or(2) Impose requirements directly on employee benefit plans.
(1) Regulate the design or administration of employee benefit plans; or
(2) Impose requirements directly on employee benefit plans.
(f) This section applies to the trade practices of pharmacy benefits managers operating in this state, including a pharmacy benefits manager's pharmacy benefits manager network participation requirements and marketing or sale of pharmacy benefits manager network products and services, as permitted under state law.
(g) This section is enforceable with respect to a pharmacy benefits manager's compliance with state rules regarding healthcare provider equity and market practices.
(h) (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) Providing a process for resolving disputes between pharmacies, pharmacists, and pharmacy benefits managers;(B) Ensuring compliance with state and federal laws; and(C) Monitoring compliance with this section by licensed pharmacy benefits managers.
(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) Providing a process for resolving disputes between pharmacies, pharmacists, and pharmacy benefits managers;(B) Ensuring compliance with state and federal laws; and(C) Monitoring compliance with this section by licensed pharmacy benefits managers.
(A) Providing a process for resolving disputes between pharmacies, pharmacists, and pharmacy benefits managers;
(B) Ensuring compliance with state and federal laws; and
(C) Monitoring compliance with this section by licensed pharmacy benefits managers.
(i) (1) After notice and opportunity for a hearing, if a pharmacy benefits manager is found to have violated this section, the commissioner may:(A) Impose a fine of up to one hundred thousand dollars ($100,000) per violation;(B) Prohibit the pharmacy benefits manager from marketing, selling, or utilizing one (1) or more offending products, pharmacy benefits manager networks, or services within this state until the pharmacy benefits manager complies with this section; and(C) Revoke or suspend the license of a pharmacy benefits manager to operate in this state.(2) A penalty under subdivision (i)(1) of this section shall be enforced by the commissioner according to rules promulgated under this section.
(1) After notice and opportunity for a hearing, if a pharmacy benefits manager is found to have violated this section, the commissioner may:(A) Impose a fine of up to one hundred thousand dollars ($100,000) per violation;(B) Prohibit the pharmacy benefits manager from marketing, selling, or utilizing one (1) or more offending products, pharmacy benefits manager networks, or services within this state until the pharmacy benefits manager complies with this section; and(C) Revoke or suspend the license of a pharmacy benefits manager to operate in this state.
(A) Impose a fine of up to one hundred thousand dollars ($100,000) per violation;
(B) Prohibit the pharmacy benefits manager from marketing, selling, or utilizing one (1) or more offending products, pharmacy benefits manager networks, or services within this state until the pharmacy benefits manager complies with this section; and
(C) Revoke or suspend the license of a pharmacy benefits manager to operate in this state.
(2) A penalty under subdivision (i)(1) of this section shall be enforced by the commissioner according to rules promulgated under this section.
(j) A prohibition under this section is applicable to a person or entity that:(1) Performs the prohibited activity;(2) Causes another person or entity to perform the prohibited activity;(3) Solicits, advises, encourages, or coerces another person or entity to perform the prohibited activity;(4) Aids or attempts to aid another person or entity in performing a prohibited activity; or(5) Indirectly performs the prohibited activity.
(1) Performs the prohibited activity;
(2) Causes another person or entity to perform the prohibited activity;
(3) Solicits, advises, encourages, or coerces another person or entity to perform the prohibited activity;
(4) Aids or attempts to aid another person or entity in performing a prohibited activity; or
(5) Indirectly performs the prohibited activity.