This bill proposes significant updates to the statutes governing pharmacy benefit managers (PBMs) in Arizona. It introduces new provisions that prohibit PBMs from reimbursing pharmacists or pharmacies for prescription drugs or devices at amounts lower than the actual costs incurred by them. Additionally, it 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. The bill also outlines specific requirements for appeal processes regarding reimbursement rates, including timelines for filing appeals and the obligations of PBMs to respond to appeals.

Furthermore, the bill defines key terms and establishes criteria for what constitutes "similarly situated pharmacists or pharmacies." It requires PBMs to include appeal procedures in their contracts with pharmacists and allows for agents to file appeals on behalf of pharmacies. The provisions of this bill will apply to contracts entered into, amended, extended, or renewed after December 31, 2025, thereby ensuring that the new regulations are implemented in a timely manner. Overall, the bill aims to enhance transparency and fairness in the reimbursement practices of PBMs, ultimately benefiting pharmacists and pharmacies in Arizona.

Statutes affected:
Introduced Version: 20-3335