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23-92-506. Compensation — Prohibited practices.
Arkansas Code — all titles (historical 2020) · legal_authorities
23-92-506. Compensation — Prohibited practices.
(a)(1) The Insurance Commissioner may review and approve the compensation program of a pharmacy benefits manager with a health benefit plan to ensure that the reimbursement for pharmacist services paid to a pharmacist or pharmacy is fair and reasonable to provide an adequate pharmacy benefits manager network for a health benefit plan under the standards issued by rule of the State Insurance Department.
(2) All information and data acquired during the review under subdivision (a)(1) of this section is:
(A) Considered proprietary and confidential under § 23-61-107(a)(4) and § 23-61-207; and
(B) Not subject to the Freedom of Information Act of 1967, § 25-19-101 et seq.
(b) A pharmacy benefits manager or representative of a pharmacy benefits manager shall not:
(1) Cause or knowingly permit the use of any advertisement, promotion, solicitation, representation, proposal, or offer that is untrue, deceptive, or misleading;
(2) Unless reviewed and approved by the commissioner, charge a pharmacist or pharmacy a fee related to the adjudication of a claim, including without limitation a fee for:
(A) The receipt and processing of a pharmacy claim;
(B) The development or management of claims processing services in a pharmacy benefits manager network; or
(C) Participation in a pharmacy benefits manager network;
(3) Unless reviewed and approved by the commissioner in coordination with the Arkansas State Board of Pharmacy, require pharmacy accreditation standards or certification requirements inconsistent with, more stringent than, or in addition to requirements of the board;
(4)(A) Reimburse a pharmacy or pharmacist in the state an amount less than the amount that the pharmacy benefits manager reimburses a pharmacy
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-92-506
Stored review status: Historical 2020-11-06 source release; later amendments not reconciled; machine-extracted, not independently legally reviewed; source heading status: text_in_historical_source. A text match is a research starting point; applicability is not established.
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Stable record: arkansas_code:legal_authorities:23-92-506
Source file: gov.ar.code.title.23.odt
Pages: Not recorded – Not recorded
Passage SHA-256: 0642ef02a95a744c8dfa7584dfff56feafef6f3eaa0db0a13896ab9dc37c8c00
Source location: content.xml paragraph 56227
Stored source content
23-92-506. Compensation — Prohibited practices.
(a)(1) The Insurance Commissioner may review and approve the compensation program of a pharmacy benefits manager with a health benefit plan to ensure that the reimbursement for pharmacist services paid to a pharmacist or pharmacy is fair and reasonable to provide an adequate pharmacy benefits manager network for a health benefit plan under the standards issued by rule of the State Insurance Department.
(2) All information and data acquired during the review under subdivision (a)(1) of this section is:
(A) Considered proprietary and confidential under § 23-61-107(a)(4) and § 23-61-207; and
(B) Not subject to the Freedom of Information Act of 1967, § 25-19-101 et seq.
(b) A pharmacy benefits manager or representative of a pharmacy benefits manager shall not:
(1) Cause or knowingly permit the use of any advertisement, promotion, solicitation, representation, proposal, or offer that is untrue, deceptive, or misleading;
(2) Unless reviewed and approved by the commissioner, charge a pharmacist or pharmacy a fee related to the adjudication of a claim, including without limitation a fee for:
(A) The receipt and processing of a pharmacy claim;
(B) The development or management of claims processing services in a pharmacy benefits manager network; or
(C) Participation in a pharmacy benefits manager network;
(3) Unless reviewed and approved by the commissioner in coordination with the Arkansas State Board of Pharmacy, require pharmacy accreditation standards or certification requirements inconsistent with, more stringent than, or in addition to requirements of the board;
(4)(A) Reimburse a pharmacy or pharmacist in the state an amount less than the amount that the pharmacy benefits manager reimburses a pharmacy benefits manager affiliate for providing the same pharmacist services.
(B) The amount shall be calculated on a per-unit basis using the same generic product identifier or generic code number;
(5)(A) Pay or reimburse a pharmacy or pharmacist for the ingredient drug product component of pharmacist services less than the national average drug acquisition cost or, if the national average drug acquisition cost is unavailable, the wholesale acquisition cost.
(B)(i) The Employee Benefits Division community pharmacy reimbursement model for pharmacist services in partnership with the University of Arkansas for Medical Sciences-based prescription drug program satisfies the intent of this subdivision (b)(5).
(ii) A plan using the model described in subdivision (b)(5)(B)(i) of this section is exempt from complying with subdivision (b)(5)(A) of this section if the reimbursement model is maintained as determined by the Insurance Commissioner.
(iii) If a plan deviates from this reimbursement model, the plan shall be subject to subdivision (b)(5)(A) of this section;
(6) Make or permit any reduction of payment for pharmacist services by a pharmacy benefits manager or a healthcare insurer directly or indirectly to a pharmacy under a reconciliation process to an effective rate of reimbursement, including without limitation generic effective rates, brand effective rates, direct and indirect remuneration fees, or any other reduction or aggregate reduction of payment; or
(7) Do any combination of the actions listed in subdivisions (b)(1)-(6) of this section.
(c) A claim or aggregate of claims for pharmacist services shall not be directly or indirectly retroactively denied or reduced after adjudication of the claim or aggregate of claims unless:
(1) The original claim was submitted fraudulently;
(2) The original claim payment was incorrect because the pharmacy or pharmacist had already been paid for the pharmacist services; or
(3) The pharmacist services were not properly rendered by the pharmacy or pharmacist.
(d) Termination of a pharmacy or pharmacist from a pharmacy benefits manager network shall not release the pharmacy benefits manager from the obligation to make any payment due to the pharmacy or pharmacist for pharmacist services properly rendered.
(e) The commissioner may issue a rule establishing prohibited practices of pharmacy benefits managers providing claims processing services or other prescription drug or device services for health benefit plans.
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Arkansas Code — all titles (historical 2020) · legal_authorities
23-61-107. Records.
(a)(1) The Insurance Commissioner shall enter, in permanent form, records of his or her official transactions, examinations, investigations, and proceedings and keep these records in his or her office.
(2) These records and insurance filings in his or her office shall be open to public inspection, except as otherwise provided in the Arkansas Insurance Code with respect to particular records or filings.
(3) Confidential data and reports provided to the commissioner by the National Association of Insurance Commissioners, including, but not limited to, insurers' Insurance Regulatory Information System ratios and examiner team synopses, shall be deemed privileged communications. These data and reports shall not be open to public inspection and shall not be admissible in evidence in any action or proceeding, other than those brought by the commissioner, nor shall any insurers, agents, or brokers, which may be the subject of the confidential reports, have a cause of action against the commissioner or his or her deputies, examiners, assistants, or employees or against the National Association of Insurance Commissioners, or its members, subscribers, officers, directors, assistants, or employees by reason of the furnishing of any such information to the commissioner.
(4) The commissioner shall maintain as confidential, and not subject to subpoena, financial information regarding material transactions of insurers, as defined in § 23-63-1403 or other applicable laws or rules promulgated by the commissioner.
(5)(A) In order to assist in the performance of the commissioner's duties, the commissioner may:
(i) Share documents, materials, or other information, including confidential and privileged documents, materials, or information, with other state, f
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-61-107
Stored review status: Historical 2020-11-06 source release; later amendments not reconciled; machine-extracted, not independently legally reviewed; source heading status: text_in_historical_source. The source passage cites 23-61-107. This identifies an authority to review, not proof of applicability.
Arkansas Code — all titles (historical 2020) · legal_authorities
23-61-207. Confidentiality of ancillary information.
All working papers, recorded information, documents, and copies produced by, obtained by, or disclosed to the Insurance Commissioner or any other person in the course of an examination made under this subchapter must be given confidential treatment and are not subject to subpoena and may not be made public by the commissioner or any other person, except to the extent provided in § 23-61-205. In addition, all workpapers, financial statement analyses, ratio calculations, and any other materials produced by State Insurance Department financial examiners or analysts, or documents submitted or disclosed to the department by an insurer in response to a request from the commissioner or a department financial examiner or analyst during the course of reviewing or investigating the financial solvency, condition, or affairs of an insurer, shall be confidential and not subject to subpoena, except to the extent as provided in § 23-61-205. Access may also be granted to the National Association of Insurance Commissioners. The parties must agree in writing prior to receiving the information to provide to it the same confidential treatment as required by this section, unless the prior written consent of the company to which it pertains has been obtained.
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-61-207
Stored review status: Historical 2020-11-06 source release; later amendments not reconciled; machine-extracted, not independently legally reviewed; source heading status: text_in_historical_source. The source passage cites 23-61-207. This identifies an authority to review, not proof of applicability.
Arkansas Code — all titles (historical 2020) · legal_authorities
25-19-101. Title.
This chapter shall be known and cited as the “Freedom of Information Act of 1967”.
Source: Arkansas Code — historical release 78 (November 6, 2020) · 25-19-101
Stored review status: Historical 2020-11-06 source release; later amendments not reconciled; machine-extracted, not independently legally reviewed; source heading status: text_in_historical_source. The source passage cites 25-19-101. This identifies an authority to review, not proof of applicability.