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Arkansas General Assembly· SB 475Notification that SB475 is now Act 773

An act TO ESTABLISH THE PHARMACY SERVICES 10 ADMINISTRATIVE ORGANIZATION ACT, the official text

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Stricken language would be deleted from and underlined language would be added to present law.

1 State of Arkansas         As Engrossed: S3/19/25 S4/2/25
2 95th General Assembly
                                     A Bill

3 Regular Session, 2025                                           SENATE BILL 475

4

5 By: Senator J. Dismang

6 By: Representative Eaves

7

8                           For An Act To Be Entitled

9   AN ACT TO ESTABLISH THE PHARMACY SERVICES

10  ADMINISTRATIVE ORGANIZATION ACT; TO REGULATE PHARMACY

11  SERVICES ADMINISTRATIVE ORGANIZATIONS; AND FOR OTHER

12  PURPOSES.

13

14

15                               Subtitle

16                       TO ESTABLISH THE PHARMACY SERVICES

17                       ADMINISTRATIVE ORGANIZATION ACT; AND TO

18                       REGULATE PHARMACY SERVICES

19                       ADMINISTRATIVE ORGANIZATIONS.

20

21 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF ARKANSAS:

22

23  SECTION 1. Arkansas Code Title 23, Chapter 99, is amended to add an

24 additional subchapter to read as follows:

25  Subchapter 19 -- Pharmacy Services Administrative Organization Act

26

27  23-99-1901. Title.

28  This subchapter shall be known and may be cited as the "Pharmacy

29 Services Administrative Organization Act".

30

31  23-99-1902. Definitions.

32  As used in this subchapter:

33  (1)(A) "Administrative services" means a service provided by a

34 pharmacy services administrative organization.

35                        (B) "Administrative services" includes without limitation:

36                          (i) Assistance with a claim;

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1                       (ii) Assistance with an audit;

2                       (iii) Assistance with access to a pharmacy network;

3                       (iv) Assistance with interactions between a pharmacy

4 and a pharmacy benefits manager;

5                       (v) Centralized payment;

6                       (vi) Certification in a specialized care program;

7                       (vii) Compliance support;

8                       (viii) Setting a flat fee for generic drugs;

9                       (ix) Assistance with store layout;

10                      (x) Marketing support;

11                      (xi) Management and analysis of payment and drug

12 dispensing data; or

13                      (xii) Provision of resources for a retail cash card;

14            (2) "Pharmacy benefits manager" means a person or an entity

15 operating within this state that contracts with a health benefit plan, an

16 employer, or a union to administer or manage prescription drug benefits on

17 behalf of a healthcare insurer that provides prescription drug benefits;

18            (3)(A) "Pharmacy services administrative organization" means an

19 entity operating within this state that contracts with one (1) or more

20 pharmacies to conduct business on their behalf with a third-party payer.

21            (B) "Pharmacy services administrative organization"

22 includes a person or entity that performs one (1) or more administrative

23 services on behalf of one (1) or more pharmacies and negotiates and enters a

24 contract with a third-party payer or pharmacy benefits manager on behalf of a

25 pharmacy;

26            (4) "Pharmacy services administrative organization-pharmacy

27 contract" means a contractual agreement between a pharmacy services

28 administrative organization and a pharmacy by which a pharmacy services

29 administrative organization agrees to negotiate with a third-party payer on

30 behalf of a pharmacy and to provide other services as stated in the pharmacy

31 services administrative organization-pharmacy contract; and

32            (5)(A) "Third-party payer" means an organization operating

33 within this state that pays or insures health, medical, or prescription drug

34 expenses on behalf of beneficiaries.

35            (B) "Third-party payer" includes a:

36                      (i) Plan sponsor;

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1                   (ii) Healthcare service plan;

2                   (iii) Health maintenance organization; or

3                   (iv) Healthcare insurer.

4                   (C) "Third-party payer" does not include a nonfederal

5 governmental plan as defined in 29 U.S.C. � 1002(32), as it existed on

6 January 1, 2025.

7

8   23-99-1903. Registration required.

9   (a)(1) A person or organization shall not establish or operate as a

10 pharmacy services administrative organization in Arkansas for health benefit

11 plans without obtaining a license from the Insurance Commissioner under this

12 subchapter.

13              (2) The commissioner shall prescribe the application for a

14 license to operate in Arkansas as a pharmacy services administrative

15 organization and may charge application fees and renewal fees as established

16 by rule.

17  (b) The commissioner shall issue rules establishing the licensing,

18 fees, application, financial standards, penalties, compliance and enforcement

19 requirements, and reporting requirements of a pharmacy services

20 administrative organization under this subchapter.

21  (c) This subchapter does not require a third-party payer to enter a

22 contract with a pharmacy services administrative organization.

23

24  23-99-1904. Notice and disclosure requirements.

25  (a) A pharmacy services administrative organization-pharmacy contract

26 shall include a provision that requires a pharmacy services administrative

27 organization to provide to a pharmacy a copy of the pharmacy services

28 administrative organization-pharmacy contract, amendment, payment schedule,

29 or reimbursement rates within three (3) calendar days after the execution of

30 a pharmacy services administrative organization-pharmacy contract, or an

31 amendment to a pharmacy services administrative organization-pharmacy

32 contract, signed on behalf of the pharmacy.

33  (b) A pharmacy services administrative organization shall disclose to

34 the State Insurance Department the extent of any ownership or control of the

35 pharmacy services administrative organization by a parent company,

36 subsidiary, or other organization that:

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1   (1) Provides pharmacy services or support;

2   (2) Provides prescription drug or device services; or

3   (3) Manufactures, sells, or distributes prescription drugs,

4 biologicals, or medical devices.

5   (c) A pharmacy services administrative organization shall notify the

6 department in writing within five (5) calendar days of any material change in

7 its ownership or control relating to any company, subsidiary, or other

8 organization described in subsection (b) of this section.

9   (d)(1) Before entering into a pharmacy services administrative

10 organization-pharmacy contract, a pharmacy services administrative

11 organization shall disclose to a pharmacy a written disclosure of ownership

12 or control in order to assist the pharmacy in making an informed decision

13 regarding its relationship with the pharmacy services administrative

14 organization.

15  (2) The disclosure required under subdivision (d)(1) of this

16 section shall include the extent of any ownership or control by a parent

17 company, subsidiary, or other organization that:

18                (A) Provides pharmacy services or support;

19                (B) Provides prescription drug or device services; or

20                (C) Manufactures, sells, or distributes prescription

21 drugs, biologicals, or medical devices.

22  (e) A pharmacy services administrative organization-pharmacy contract

23 shall provide that the pharmacy services administrative organization shall

24 notify the pharmacy in writing within five (5) calendar days of any material

25 change in its ownership or control related to any company, subsidiary, or

26 other organization described in subdivision (d)(1) of this section.

27  (f)(1) Before entering into a contract with a third-party payer, a

28 pharmacy services administrative organization shall furnish to a pharmacy

29 benefits manager or a third-party payer a written disclosure of ownership or

30 control in order to assist the pharmacy benefits manager or the third-party

31 payer in making an informed decision regarding the pharmacy benefits

32 manager's or the third-party payer's relationship with the pharmacy services

33 administrative organization and the pharmacy or pharmacies for which the

34 pharmacy services administrative organization is negotiating.

35  (2) The disclosure required under subdivision (f)(1) of this

36 section shall include the extent of any ownership or control by any parent

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1 company, subsidiary, or other organization that:

2   (A) Provides pharmacy services or support;

3   (B) Provides prescription drug or device services; or

4   (C) Manufactures, sells, or distributes prescription

5 drugs, biologicals, or medical devices.

6   (g) A pharmacy services administrative organization-pharmacy contract

7 with a third-party payer shall require that a pharmacy services

8 administrative organization shall notify the third-party payer in writing

9 within five (5) calendar days of any material change in its ownership or

10 control related to any company, subsidiary, or other organization described

11 in subdivision (f)(1) of this section.

12

13  23-99-1905. Wholesale and pharmacy services administrative

14 organization services -- Single pharmacy services administrative organization-

15 pharmacy contract.

16  (a) A pharmacy services administrative organization that owns or is

17 owned by, in whole or in part, an entity that manufactures, sells, or

18 distributes prescription drugs, biologicals, or medical devices, as a

19 condition of entering into a pharmacy services administrative organization-

20 pharmacy contract, shall not require that the pharmacy purchase any drugs or

21 medical devices solely from the entity with which the pharmacy services

22 administrative organization has an ownership interest or from an entity with

23 an ownership interest in the pharmacy services administrative organization.

24  (b) A pharmacy services administrative organization that owns or is

25 owned by, in whole or in part, an entity that manufactures, sells, or

26 distributes prescription drugs, biologicals, or medical devices shall

27 disclose to the State Insurance Department any agreement with a pharmacy in

28 which the pharmacy purchases prescription drugs, biologicals, or medical

29 devices from a pharmacy services administrative organization or from an

30 entity that owns or is owned by, in whole or in part, the pharmacy services

31 administrative organization.

32

33  23-99-1906. Notice of appeals.

34  (a) A pharmacy services administrative organization-pharmacy contract

35 shall provide that if there is a dispute between a pharmacy and a pharmacy

36 benefits manager or a third-party payer, the pharmacy services administrative

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1 organization shall ensure and facilitate timely communication from the

2 pharmacy to the pharmacy benefits manager or the third-party payer.

3   (b) A pharmacy services administrative organization-pharmacy contract

4 shall provide that the pharmacy services administrative organization shall

5 forward a notice of appeal from a pharmacy to the pharmacy benefits manager

6 or the third-party payer in a timely manner.

7   (c) If an appeal does not meet the minimum requirements described in

8 the pharmacy services administrative organization-pharmacy contract, the

9 pharmacy services administrative organization shall:

10              (1) Provide the pharmacy with the reason for the denial of the

11 appeal; and

12              (2) Allow the pharmacy to resubmit the appeal for a review by a

13 pharmacy benefits manager.

14  (d) In connection with an appeal or similar process under � 17-92-507,

15 a third-party payer's or pharmacy benefits manager's notice or provision of

16 information to a pharmacy services administrative organization is deemed to

17 be notice or provision of information to the pharmacy on whose behalf the

18 pharmacy services administrative organization has contracted.

19

20  23-99-1907. Enforcement.

21  (a) The Insurance Commissioner shall enforce this subchapter.

22  (b)(1) The commissioner may examine or audit the books and records of

23 a pharmacy services administrative organization providing claims

24 administrative services for a pharmacy to determine if the pharmacy services

25 administrative organization is in compliance with this subchapter.

26              (2) The information or data acquired during an examination under

27 subdivision (b)(1) of this section is:

28              (A) Considered proprietary and confidential under �� 23-

29 61-107(a)(4) and 23-61-207; and

30              (B) Not subject to the Freedom of Information Act of 1967,

31 � 25-19-101 et seq.

32  (c) After notice and opportunity for hearing, the commissioner may:

33              (1) Impose a civil penalty of up to five thousand dollars

34 ($5,000) per violation against a pharmacy services administrative

35 organization if the commissioner finds that the pharmacy services

36 administrative organization has violated this subchapter; or

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1   (2) Revoke or suspend the license of a pharmacy services

2 administrative organization.

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4                                   /s/J. Dismang

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