23-92-503. Definitions.

23-92-503. Definitions. As used in this subchapter: (1) “Claims processing services” means the administrative services performed in connection with the processing and adjudicating of claims relating to pharmacist services that include: (A) Receiving payments for pharmacist services; (B) Making payments to pharmacists or pharmacies for pharmacist services; or (C) Both subdivisions (1)(A) and (B) of this section; (2)(A) “Health benefit plan” means any individual, blanket, or group plan, policy, or contract for healthcare services issued or delivered by a healthcare insurer in this state. (B) “Health benefit plan” does not include: (i) Accident-only plans; (ii) Specified disease plans; (iii) Disability income plans; (iv) Plans that provide only for indemnity for hospital confinement; (v) Long-term care only plans that do not include pharmacy benefits; (vi) Other limited-benefit health insurance policies or plans; or (vii) Health benefit plans provided under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et seq., and the Public Employee Workers' Compensation Act, § 21-5-601 et seq.; (3) “Healthcare insurer” means an insurance company, a health maintenance organization, or a hospital and medical service corporation; (4) “Other prescription drug or device services” means services other than claims processing services, provided directly or indirectly, whether in connection with or separate from claims processing services, including without limitation: (A) Negotiating rebates, discounts, or other financial incentives and arrangements with drug companies; (B) Disbursing or distributing rebates; (C) Managing or participating in incentive programs or arrangements for pharmacist services; (D) Negotiating or entering into contractual arrangements with pharmacists or pharmacies, or both; (E) Developing formularies; (F) Designing prescription benefit programs; or (G) Advertising or promoting services; (5) “Pharmacist” means an individual licensed as a pharmacist by the Arkansas State Board of Pharmacy; (6) “Pharmacist services” means products, goods, and services, or any combination of products, goods, and services, provided as a part of the practice of pharmacy as defined in § 17-92-101; (7) “Pharmacy” means the same as defined in § 17-92-101; (8)(A) “Pharmacy benefits manager” means a person, business, or entity, including a wholly or partially owned or controlled subsidiary of a pharmacy benefits manager, that provides claims processing services or other prescription drug or device services, or both, for health benefit plans. (B) “Pharmacy benefits manager” does not include any: (i) Healthcare facility licensed in Arkansas; (ii) Healthcare professional licensed in Arkansas; (iii) Consultant who only provides advice as to the selection or performance of a pharmacy benefits manager; or (iv) Entity that provides claims processing services or other prescription drug or device services for the fee-for-service Arkansas Medicaid Program only in that capacity; (9) “Pharmacy benefits manager affiliate” means a pharmacy or pharmacist that directly or indirectly, through one (1) or more intermediaries, owns or controls, is owned or controlled by, or is under common ownership or control with a pharmacy benefits manager; (10) “Pharmacy benefits manager network” means a network of pharmacists or pharmacies that are offered by an agreement or insurance contract to provide pharmacist services for health benefit plans; (11) “Pharmacy benefits plan or program” means a plan or program that pays for, reimburses, covers the cost of, or otherwise provides for pharmacist services under a health benefit plan; (12) “Pharmacy services administrative organization” means an organization that helps community pharmacies and pharmacy benefits managers or third-party payers achieve administrative efficiencies, including contracting and payment efficiencies; (13)(A) “Rebate” means a discount or other price concession, or a payment that is: (i) Based on utilization of a prescription drug; and (ii) Paid by a manufacturer or third party, directly or indirectly, to a pharmacy benefits manager, pharmacy services administrative organization, or pharmacy after a claim has been processed and paid at a pharmacy. (B) “Rebate” includes without limitation incentives, disbursements, and reasonable estimates of a volume-based discount; (14) “Spread pricing” means the model of prescription drug pricing in which the pharmacy benefits manager charges a health benefit plan a contracted price for prescription drugs, and the contracted price for the prescription drugs differs from the amount the pharmacy benefits manager directly or indirectly pays the pharmacist or pharmacy for pharmacist services; and (15) “Third party” means a person, business, or entity other than a pharmacy benefits manager that is not an enrollee or insured in a health benefit plan.