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ARIZONA STATE SENATE
Fifty-Fourth Legislature, First Regular Session
unfair claims practices; cost sharing
(NOW: insurance; cost-sharing; calculation)
Purpose
Requires a health care insurer, when calculating an enrollee's contribution, to include any cost-sharing amount paid by an enrollee.
Background
Current statute defines a pharmacy benefits manager as a person, business or other entity that, pursuant to a contract or under an employment relationship with a carrier or other third-party payer, either directly or through an intermediary manages the prescription drug coverage provided by the carrier or other third-party payer, including the processing and payment of claims for prescription drugs, the performance of drug utilization review, the processing of drug prior authorization requests, the adjudication of appeals and grievances related to prescription drug coverage, contracting with network pharmacies and controlling the cost of covered prescription drugs (A.R.S. § 20-3321).
There is no anticipated fiscal impact to the state General Fund associated with this legislation.
Provisions
1. Requires a health care insurer that provides pharmacy benefits or a pharmacy benefits manager that administers pharmacy benefits for a health care insurer, when calculating an enrollee's contribution to any out-of-pocket maximum, deductible, copayment, coinsurance or other applicable cost-sharing requirement, to include any cost-sharing amount paid by either the enrollee or another person on behalf of the enrollee.
2. Defines a health care insurer as a disability insurer, group disability insurer, blanket disability insurer, health care services organization, hospital service corporation, medical service corporation or a hospital, medical, dental and optometric service corporation.
3. Becomes effective on the general effective date.
House Action
HHS 2/21/19 DPA/SE 7-1-1-0
3rd Read 3/4/19 58-0-2
Prepared by Senate Research
March 18, 2019
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