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REFERENCE TITLE: pharmacy benefits; workers' compensation |
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State of Arizona House of Representatives Fifty-seventh Legislature Second Regular Session 2026
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HB 2813 |
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Introduced by Representative Livingston
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AN ACT
amending title 23, chapter 6, article 9, arizona revised statutes, by adding section 23-1062.04; relating to workers' compensation.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Title 23, chapter 6, article 9, Arizona Revised Statutes, is amended by adding section 23-1062.04, to read:
23-1062.04. Pharmacy benefits; pharmacy management network; notice; registration; fees; disputes; rules
A. An employer or insurer may establish or contract with a formal pharmacy management network to provide necessary medications to injured employees.
B. A formal pharmacy management network may contract for reimbursement amounts that are different from the fee schedule established by the commission pursuant to section 23-908.
C. A formal pharmacy management network may not reimburse a pharmacy provider for an amount that is less than the pharmacy's actual cost of the medication ordered for the injured employee plus the dispensing fee established by the commission.
D. For the purposes of this section, a pharmacy services administrative organization is not considered an employer's formal pharmacy management network or an agent of a contract pharmacy or dispensing provider.
E. An informal, voluntary pharmacy management network may be used by an injured employee on a voluntary basis and is not subject to this section.
F. An employer or insurer that establishes a formal pharmacy management network shall do both of the following:
1. When an employer or insurer initially establishes the formal pharmacy management network, the employer or the insurer shall notify employees by posting a notice in a prominent location at the workplace or by providing the information in hardcopy or by electronic means that employees may use the pharmacy management network and how to fill a prescription.
2. At the time of a reported injury, notify the employee on how to use the formal pharmacy management network and provide a list of participating network pharmacies and providers in hardcopy or by electronic means.
G. Out-of-network prescriptions from retail pharmacies or dispensing providers for medications that are reasonably required for the period of disability and that are related to a compensable claim shall be reimbursed at the pharmacy fee schedule amount established by the commission UNTIL the payor or formal pharmacy management network provides to the out-of-network pharmacy or dispensing provider a notice that contains all of the following:
1. Notice that the injured employee is required to receive prescriptions from a pharmacy or dispensing provider that participates in the established formal pharmacy management network.
2. Notice that future medication refills by the out-of-network pharmacy or dispensing provider will not be reimbursed.
3. An invitation to the pharmacy or dispensing provider to join the formal pharmacy management network, if desired.
H. A formal pharmacy management network shall accept as part of the formal pharmacy management network any pharmacy or dispensing provider that is licensed and in good standing and is willing to abide by the formal pharmacy management network's contract terms.
I. A formal pharmacy management network shall register with the commission and submit a form as prescribed by the commission. A formal pharmacy management network shall pay a registration fee in an amount established by the commission in rule.
J. A formal pharmacy management network shall provide a timely process for pharmacies and dispensing providers to dispute a denial or amount of reimbursement of a pharmaceutical bill.
K. A formal pharmacy management network or a contracted formal pharmacy management network shall perform audits of pharmacies and dispensing providers.
L. A formal pharmacy management network or a contracted formal pharmacy management network may not charge pharmacies or dispensing providers for any direct or indirect fees associated with dispensing, processing or billing of a prescription drug or medication that is dispensed to an injured employee or any fee related to the enrollment or annual reenrollment of the pharmacy in the network or credentialing.
M. A pharmacy processing agent or third-party biller that accepts the assignment of bills from a pharmacy or dispensing provider that is contracted with a formal pharmacy management network must be reimbursed at the contractual amount agreed to by the assigning pharmacy or dispensing provider.
N. If a claim is disputed for compensability, an injured employee is not required to use a pharmacy or dispensing provider in the formal pharmacy management network until the claim dispute is resolved and the formal pharmacy management network provides notice to the parties that the claim is accepted. The injured employee is required to obtain medications through the formal pharmacy management network.
O. A formal pharmacy management network that is registered with this state and provides pharmacy services under this section is exempt from title 20, chapter 25, article 2.
P. The commission may adopt rules necessary to implement the REQUIREMENTS of this section.
Q. For the purposes of this section, employer does not include a self-insured employer that elects to provide medical care pursuant to section 23-1070.
Sec. 2. Effective date
Section 23-1062.04, Arizona Revised Statutes, as added by this act, is effective from and after December 31, 2026.