Bill > HB2208

This bill establishes new regulations for pharmacy benefit managers (PBMs) regarding prescription drug and device reimbursement. The bill requires PBMs to reimburse pharmacists and pharmacies at least the actual cost of the prescription, prohibits using professional dispensing fees to meet this requirement, and mandates that PBMs pay a professional dispensing fee at a rate consistent with state medical assistance plans. The legislation creates a detailed appeals process for pharmacists and pharmacies who believe they have been reimbursed incorrectly, requiring appeals to be filed within seven business days of reimbursement. If a pharmacist or pharmacy wins an appeal, the PBM must make corrections, provide necessary drug information, allow claim rebilling, and reimburse the actual cost. Conversely, if the PBM wins an appeal, they must provide information about wholesalers with the drug in stock at the challenged reimbursement cost. The bill includes provisions for non-compliance, such as adjusting reimbursement costs and allowing claim reversals. Importantly, the new regulations will apply to contracts entered into, amended, extended, or renewed on or after December 31, 2025, and do not apply to certain health insurance coverage procured by the state administration.

Budget and Finance, Health and Social Services

https://apps.azleg.gov/BillStatus/BillOverview/81951