Bill > HB2813

This bill establishes rules for how employers and insurers in Arizona can manage pharmacy benefits for injured employees through a "formal pharmacy management network," which is a group of pharmacies and providers that have agreed to specific contract terms. Employers or insurers can create or contract with these networks, which can negotiate different reimbursement rates than the standard fee schedule, but they cannot reimburse pharmacies less than the pharmacy's actual cost for the medication plus a dispensing fee. The bill clarifies that certain organizations are not considered formal networks and that informal, voluntary networks are not subject to these rules. Employers must notify employees about the network and how to use it, both generally and at the time of an injury, providing a list of participating pharmacies. If an employee uses an out-of-network pharmacy, the employer or network must notify the pharmacy that the employee is required to use the network for future refills and invite them to join. Formal networks must accept any licensed and willing pharmacy or provider, register with the state, pay a fee, and provide a process for pharmacies to dispute reimbursement denials. They cannot charge pharmacies fees related to dispensing, processing, billing, enrollment, or credentialing. The bill also states that if a workers' compensation claim is disputed, the employee doesn't have to use the network until the claim is accepted. Finally, it exempts registered formal pharmacy management networks from certain insurance regulations and allows the commission to adopt necessary rules, with an effective date of December 31, 2026.

Budget and Finance, Health and Social Services

https://apps.azleg.gov/BillStatus/BillOverview/84636