Arizona Laws 20-3331. Pharmacy benefit managers; requirements; applicability
A. A pharmacy benefit manager shall do all of the following:
Terms Used In Arizona Laws 20-3331
- Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
- Contract: A legal written agreement that becomes binding when signed.
- List: means the list of drugs for which a pharmacy benefit manager has established a maximum allowable cost. See Arizona Laws 20-3321
- Pharmacy benefit manager: means a person, business or other entity that, pursuant to a contract or under an employment relationship with an insurer or other third-party payor, either directly or through an intermediary manages the prescription drug coverage provided by the insurer or other third-party payor, including the processing and payment of claims for prescription drugs, the performance of drug utilization review, the processing of drug prior authorization requests, the adjudication of appeals or grievances related to prescription drug coverage, contracting with network pharmacies and controlling the cost of covered prescription drugs. See Arizona Laws 20-3321
- Process: means a citation, writ or summons issued in the course of judicial proceedings. See Arizona Laws 1-215
1. Update the price and drug information for each list that the pharmacy benefit manager maintains every seven business days.
2. At the beginning of the term of a contract, on renewal of a contract and at least once annually during the term of a contract, make available to each network pharmacy the sources used to determine maximum allowable cost pricing.
3. Establish a process by which a network pharmacy may appeal its reimbursement for a drug subject to maximum allowable cost pricing.
4. Allow a pharmacy services administrative organization that is contracted with the pharmacy benefit manager to file an appeal of a drug on behalf of the organization’s contracted pharmacies.
B. Beginning on January 1, 2020, this section applies to all new and existing contracts between a pharmacy benefit manager and a licensed pharmacy.