A. A pharmacy benefit manager may not directly or indirectly, on behalf of itself, a plan sponsor or an insurer, charge or hold a pharmacist or pharmacy responsible for a fee for any step of or component or mechanism related to the claims adjudication process, including:

Terms Used In Arizona Laws 20-3332

  • Action: includes any matter or proceeding in a court, civil or criminal. See Arizona Laws 1-215
  • Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
  • Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
  • including: means not limited to and is not a term of exclusion. See Arizona Laws 1-215
  • Injunction: An order of the court prohibiting (or compelling) the performance of a specific act to prevent irreparable damage or injury.
  • Insurer: means a disability insurer, group disability insurer, blanket disability insurer, health care services organization, hospital service corporation, medical service corporation or hospital and medical service corporation. See Arizona Laws 20-3321
  • Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
  • Person: includes a corporation, company, partnership, firm, association or society, as well as a natural person. See Arizona Laws 1-215
  • 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. Adjudicating a pharmacy benefit claim.

2. Processing or transmitting a pharmacy benefit claim.

3. Developing or managing a claims processing or adjudication network.

4. Participating in a claims processing or adjudication network.

B. A pharmacy may submit a complaint of a violation of this chapter to the director. The pharmacy must include supporting documentation at the time the pharmacy files the complaint. The director shall investigate the complaint and may examine and audit the books and records of a pharmacy benefit manager to determine if the pharmacy benefit manager has committed a violation of this chapter. If the director finds that a pharmacy benefit manager has committed a violation of this chapter, the director may:

1. Seek an injunction in a court of competent jurisdiction and may apply for temporary and permanent orders that the director determines are necessary to restrain the pharmacy benefit manager from continuing to commit the violation.

2. Issue a cease and desist order pursuant to section 20-456 on the pharmacy benefit manager.

C. A pharmacy benefit manager that commits a violation of this chapter is subject to the penalties prescribed in section 20-456.

D. In addition to the actions and penalties prescribed in subsections B and C of this section, any person who is damaged by the acts of a pharmacy benefit manager committed in violation of this chapter may bring a civil action for damages against the pharmacy benefit manager committing the violation in a court of competent jurisdiction.

  Previous section
Next section  
 Article 2 Contents