The proposed bill introduces significant changes to the Arizona Revised Statutes concerning pharmacy benefits. It mandates that accountable health plans demonstrate to the department how they will reduce consumer costs through manufacturer rebates and other incentives received by the plan or its affiliated pharmacy benefit managers (PBMs). Additionally, PBMs must file a request with the department before increasing drug prices above the inflation rate, providing justification and documentation for the increase. If denied, they can request a formal hearing. The bill also requires PBMs to provide quarterly reports on drug manufacturer rebates, frequently prescribed drugs, most expensive prescribed drugs, and any other information as determined by the director.

The bill further stipulates that PBMs cannot charge more for a prescription drug than the amount paid to the pharmacy for filling and dispensing it. State-sponsored and regulated health plans, along with their affiliated PBMs, must limit drug reimbursements to not more than the upper payment limit established by the newly created Prescription Drug Affordability Division. Health care providers are also prohibited from charging more than this upper payment limit. PBMs must submit records for auditing to this division, which is responsible for promoting cost-saving mechanisms, approving or denying drug price increase requests, ensuring health insurance premiums reflect the true cost of prescription drugs, and setting upper payment limits for drugs. The division will be part of the Department of Insurance and Financial Institutions, with its director appointed by the department's director. The bill does not apply to health benefits plans not regulated by the state.

Statutes affected:
Introduced Version: 20-2311, 20-3331, 20-3335