Supported Legislation

2021-2022 Arizona Legislative Session

SB1356

Sponsor: Senator Nancy Barto

End PBM Transaction Fees

Click here to track the progress of this bill

 

Purpose: 

This bill amends Chapter 25, Article 2 of the Insurance Code by adding Section 20-3332 to prohibit PBMs operating in Arizona from holding a pharmacist or pharmacy responsible for a fee for any step or component of, or mechanism related to, the adjudication of a claim, including:

  • Adjudicating a pharmacy benefit claim;

  • Processing or transmitting a pharmacy benefit claim;

  • Developing or managing a claim processing or adjudication network; or

  • Participating in a claim processing or claim adjudication network.

 

The bill also allows a pharmacy to file a complaint with the AZ Dept. of Insurance (ADI) for a violation of Sec. 20-3332 and would grant ADI authority to seek injunctive relief to halt transaction fees or to impose penalties on, or bring legal action against, a PBM for assessing the fees.

When Passed, This Legislation Will:

  • End unfair, unjustified charges that cannot be realistically explained as anything other than a PBM practice to generate revenue at pharmacies’ expense;

  • Establish equity among Arizona health-care providers in how they are treated when submitting health-care claims for adjudication;

  • Strengthen the financial viability of Arizona pharmacies, which play a critical role during the pandemic in providing medications, vaccinations and other vital services to Arizonans.

Signed by the Governor