Section 23-92-703 - DefinitionsAs used in this subchapter:
(1) "Defined cost sharing" means a deductible payment or coinsurance amount imposed on an enrollee for a covered prescription drug under the enrollee's health benefit plan;(2) "Enrollee" means an individual entitled to coverage of healthcare services from a healthcare insurer;(3)(A) "Health benefit plan" means any individual, blanket, or group plan, policy, or contract for healthcare services issued or delivered by a healthcare insurer in this state.(B) "Health benefit plan" does not include:(ii) Specified disease plans;(iii) Disability income plans;(iv) Plans that provide only for indemnity for hospital confinement;(v) Long-term-care-only plans that do not include pharmacy benefits;(vi) Other limited-benefit health insurance policies or plans;(vii) Health benefit plans provided under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.; or(viii) Any state or local governmental employee plan;(4) "Healthcare insurer" means an insurance company that is subject to state law regulating insurance, including without limitation a health maintenance organization or a hospital and medical service corporation;(5) "Pharmacy benefits management service" means a service to:(A) Negotiate the price of prescription drugs, including negotiating and contracting for direct or indirect rebates, discounts, or other price concessions;(B) Manage any aspect of a prescription drug benefit, including without limitation: (i) Claims processing services;(ii) The performance of drug utilization review;(iii) The processing of drug prior authorization requests;(iv) The adjudication of appeals or grievances related to a prescription drug benefit;(v) Controlling the cost of covered prescription drugs; or(vi) The provision of services related to the services described under this subdivision (5)(B);(C) Disburse or distribute rebates, manage or participate in incentive programs or arrangements for pharmacist services, negotiate or enter into contractual arrangements with pharmacists or pharmacies, or both, develop formularies, or employ advertising or promotional services;(D) Perform any other administrative, managerial, clinical, pricing, financial, reimbursement, or billing service; and(E) Perform any other services as the Insurance Commissioner may include by rule;(6)(A) "Pharmacy benefits manager" means a person, business, or entity that, pursuant to a written agreement with a healthcare insurer or health benefit plan, either directly or indirectly provides one (1) or more pharmacy benefits management services on behalf of the healthcare insurer or health benefit plan, and any agent, contractor, intermediary, affiliate, subsidiary, or related entity of the person, business, or entity that facilitates, provides, directs, or oversees the provision of the pharmacy benefits management service or services.(B) "Pharmacy benefits manager" does not include a:(i) Healthcare facility licensed in Arkansas;(ii) Healthcare professional licensed in Arkansas; or(iii) Consultant who only provides advice as to the selection or performance of a pharmacy benefits manager;(7) "Price protection rebate" means a negotiated price concession that accrues directly or indirectly to a healthcare insurer, or other party on behalf of the healthcare insurer, if there is an increase in the wholesale acquisition cost of a prescription drug above a specified threshold; and(8) "Rebate" means: (A) A negotiated price concession, including without limitation base price concessions, whether described as a rebate or not, reasonable estimates of any price protection rebates, and performance-based price concessions that may accrue, directly or indirectly, to the healthcare insurer during the coverage year from a manufacturer or other party in connection with the dispensing or administration of a prescription drug; and(B) Any reasonable estimate of a negotiated price concession, fee, and other administrative cost that is passed through, or is reasonably anticipated to be passed through, to the healthcare insurer and serves to reduce the healthcare insurer's liabilities for a prescription drug.Added by Act 2023, No. 333,§ 2, eff. 8/1/2023.