2021-2022 Arizona Legislative Session
Sponsor: Senator Nancy Barto
End PBM Transaction Fees
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.