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REFERENCE TITLE: insurer responsibility; pharmacy benefits |
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State of Arizona House of Representatives Fifty-fourth Legislature First Regular Session 2019
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HB 2167 |
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Introduced by Representatives Barto: Cobb
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AN ACT
Amending section 20‑3321, Arizona Revised Statutes; amending title 20, chapter 25, Arizona Revised Statutes, by adding article 2; relating to pharmacy benefits.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Section 20-3321, Arizona Revised Statutes, is amended to read:
20-3321. Definitions
In this article chapter, unless the context otherwise requires:
1. "Auditing entity" means any person, company, group or plan working on behalf of or pursuant to a contract with an insurer or pharmacy benefits manager for the purposes of auditing pharmacy drug claims adjudicated by pharmacies.
2. "Clerical errors" means a minor recordkeeping or transcribing error, including typographical errors, scrivner's errors or computer errors, in a required electronic or hard copy document, record or prescription order if both of the following criteria are met:
(a) The error did not result in actual financial harm to an entity.
(b) The error did not involve dispensing an incorrect dose or type of medication or dispensing a prescription drug to the wrong person.
3. "Desktop audit" means an audit that is conducted by an auditing entity at a location other than the location of the pharmacist or pharmacy. Desktop audit includes an audit that is performed at the offices of the auditing entity during which the pharmacist or pharmacy provides requested documents for review by hard copy or by microfiche, disk or other electronic media.
4. "health care plan" has the same meaning prescribed in section 20‑3151.
4. 5. "In‑pharmacy audit" means an audit that is conducted by an auditing entity at the physical business address of the pharmacy where the claim was adjudicated.
5. 6. "Insurer" means a disability insurer, group disability insurer, blanket disability insurer, health care services organization, hospital service corporation, medical service corporation or hospital and medical service corporation.
6. 7. "Pharmacist" has the same meaning prescribed in section 32‑1901.
7. 8. "Pharmacy" has the same meaning prescribed in section 32‑1901.
8. 9. "Pharmacy benefits manager" means a person, business or other entity that, pursuant to a contract or under an employment relationship with a carrier an insurer or other third-party payer payor, either directly or through an intermediary manages the prescription drug coverage provided by the carrier insurer or other third-party payer payor, 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 or grievances related to prescription drug coverage, contracting with network pharmacies and controlling the cost of covered prescription drugs.
Sec. 2. Title 20, chapter 25, Arizona Revised Statutes, is amended by adding article 2, to read:
ARTICLE 2. INSURER RESPONSIBILITY
20-3331. Insurer responsibility; acts of third parties
An insurer that uses the services of a pharmacy benefits manager, an insurance affiliate, a third‑party administrator or a third‑party payor in this state is responsible for the acts of the pharmacy benefits manager, insurance affiliate, third‑party administrator or third‑party payor that are within the scope of the health care plan, including the administration of all patient claims processed by the pharmacy benefits manager, insurance affiliate, third‑party administrator or third‑party payor on behalf of the insurer.