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ARIZONA HOUSE OF REPRESENTATIVES57th Legislature, 2nd Regular Session |
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HB 2813: pharmacy benefits; workers' compensation
Sponsor: Representative Livingston, LD 28
Committee on Health & Human Services
Overview
Effective January 1, 2027, provides regulations authorizing an employer or insurer to contract with a formal pharmacy management network (pharmacy network) to provide necessary medications to injured employees.
History
Promptly, on notice to the employer, every injured employee must receive medical, surgical and hospital benefits or other treatment, nursing, medicine, surgical supplies, crutches and other apparatus, including artificial members, reasonably required at the time of the injury, and during the period of disability. Such benefits must be termed "medical, surgical and hospital benefits".
Compensation for medical, surgical and hospital benefits must include reimbursement for reasonable travel expenses if the employee must travel more than 25 miles from the employee's place of residence to obtain medical care for the injury (A.R.S. § 23-1062).
Provisions
1. Allows an employer or insurer to establish or contract with a pharmacy network to provide necessary medications to injured employees. (Sec. 1)
2. Allows a pharmacy network to contract for reimbursement amounts that are different from the fee schedule established by the Industrial Commission (Commission). (Sec. 1)
3. Prohibits a pharmacy network from reimbursing a pharmacy provider for an amount that is less than the pharmacy's actual cost of the medication for the injured employee plus the dispensing fee established by the Commission. (Sec. 1)
4. Specifies a pharmacy services administrative organization is not considered an employer's formal pharmacy network or an agent of a contract pharmacy or dispensing provider. (Sec. 1)
5. Allows an informal, voluntary pharmacy network to be used by an injured employee on a voluntary basis and is not subject to the network requirements. (Sec. 1)
6. Requires an employer or insurer that establishes a pharmacy network to notify employees by posting a notice in a prominent location at the workplace or provide the information in hardcopy or by electronic means that employees may use and how to fill a prescription. (Sec. 1)
7. Requires an employer or insurer that establishes a pharmacy network to notify the employee, at the time of a reported injury, on how to use the pharmacy network and provide a list of participating network pharmacies and providers in hardcopy or by electronic means. (Sec. 1)
8. Requires out-of-network prescriptions from retail pharmacies or dispensing providers for medications that are reasonably required for the period of disability and are related to compensable claim to be reimbursed at the pharmacy fee schedule amount established by the Commission until the payor or formal pharmacy network provides the out-of-network pharmacy or dispensing provider a notice, as outlined. (Sec. 1)
9. Requires a pharmacy network to accept as part of the formal network any pharmacy or dispensing provider that is licensed and in good standing and willing to abide by the formal pharmacy network's contract terms. (Sec. 1)
10. Requires a pharmacy network to register with the Commission and submit a form as prescribed by the Commission and pay a registration fee in an amount established by the Commission in rule. (Sec. 1)
11. Requires a pharmacy network to provide a timely process for pharmacies and dispensing providers to dispute a denial or amount of reimbursement of a pharmaceutical bill. (Sec. 1)
12. Requires a pharmacy network to perform audits of pharmacies and dispensing providers. (Sec. 1)
13. Prohibits a pharmacy network or a contracted network from charging 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. (Sec. 1)
14. Directs a pharmacy processing agent or third-party biller that accepts the assignment of bills from a pharmacy or dispensing provider that is contracted with the pharmacy network to be reimbursed at the contractual amount agreed to by the assigning pharmacy or dispensing provider. (Sec. 1)
15. Specifies that an injured employee is not required to use a pharmacy or dispensing provider in the pharmacy network until the claim dispute is resolved and it provides notice to the parties that the claim is accepted. (Sec. 1)
16. Requires the injured employee to obtain medications through the pharmacy network. (Sec. 1)
17. Exempts a pharmacy network that is registered in Arizona and provides pharmacy services from statutes relating to pharmacy benefit managers. (Sec. 1)
18. Allows the Commission to adopt rules necessary to implement the pharmacy network requirements. (Sec. 1)
19. Specifies that employers do not include a self-insured employer that elects to provide medical care. (Sec. 1)
20. Contains an effective date of January 1, 2027. (Sec. 2)
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24. Initials AG/LK HB 2813
25. 2/10/2026 Page 0 Health & Human Services
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