The proposed bill would update the Arizona Revised Statutes by introducing new sections 20-3335 and 20-3336, which would prohibit pharmacy benefit managers (PBMs) and health care insurers from limiting or excluding coverage for prescription drugs that have been previously approved for covered individuals, as long as those individuals remain insured and the drugs are part of their treatment plan. Additionally, the bill mandates that PBMs notify affected individuals and their prescribing providers at least sixty days in advance of any formulary changes that could impact drug coverage, ensuring transparency and continuity of care.

Moreover, the bill establishes a structured process for requesting formulary exceptions, requiring timely responses from insurers and PBMs to such requests. It specifies that formulary exceptions must be granted for individuals who have previously been approved for nonformulary drugs, contingent upon appropriate clinical documentation. The bill also clarifies definitions related to health care insurers and formulary exceptions, while preserving the rights of health care providers to prescribe necessary medications. These changes would take effect for contracts and policies entered into or renewed after December 31, 2025.

Statutes affected:
Introduced Version: 20-3335, 20-3336
Senate Engrossed Version: 20-3335, 20-3336
Chaptered Version: 20-3335, 20-3336