The proposed bill would update the Arizona Revised Statutes by introducing new provisions that enhance the rights of individuals regarding prescription drug coverage under pharmacy benefit managers (PBMs) and health care insurers. Specifically, it would prohibit PBMs from limiting or excluding coverage of a prescription drug for any covered individual who is already on that drug, provided certain conditions are met, such as prior approval for coverage and continued enrollment with the insurer. Additionally, it would require PBMs to maintain coverage of the drug through the end of the plan year and to notify affected individuals and their health care providers of any formulary changes at least 60 days in advance. Moreover, the bill would establish a structured process for formulary exceptions, mandating timely responses from insurers and PBMs to requests for exceptions and allowing expedited reviews in urgent cases. It would also require written notifications for any denial of coverage, detailing the reasons for denial and the appeal process. These updates would apply to contracts entered into or renewed starting January 1, 2026, and would be enforced by the Director of the Department of Insurance and Financial Institutions (DIFI) against non-compliant PBMs or insurers, ultimately aiming to improve patient access to necessary medications and enhance transparency in the prescription drug coverage process.

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