The proposed bill, if enacted, would introduce significant changes to the current statutes governing pharmacy benefit managers (PBMs) in Arizona. Specifically, it would prohibit PBMs from reimbursing pharmacists or pharmacies for prescription drugs or devices at amounts lower than the actual costs incurred by those entities. Additionally, the bill mandates that PBMs pay a professional dispensing fee that meets or exceeds the fee-for-service rates established in the state plan for medical assistance. It also outlines a structured appeals process for pharmacists and pharmacies to contest reimbursement rates that do not comply with these new requirements.

Furthermore, the bill establishes specific procedures for PBMs regarding appeals, including the requirement to file appeal procedures with the Department of Insurance and Financial Institutions (DIFI) for approval. It stipulates that if a pharmacist or pharmacy prevails in an appeal, the PBM must take corrective actions within seven business days, such as adjusting reimbursement costs and providing necessary drug information. The bill also defines key terms and clarifies that these provisions will apply to contracts entered into or renewed after December 31, 2025. Overall, the bill aims to enhance the financial fairness and transparency of pharmacy reimbursements in Arizona.

Statutes affected:
Introduced Version: 20-3335