ARKANSAS SUMMARY OF EXISTING LAW

A PBM is prohibited from:
(i) reimbursing a pharmacy or pharmacist in the state an amount less than the amount that the PBM reimburses a PBM affiliate for providing the same pharmacist services;
(ii)reimbursing a pharmacy or pharmacist for the ingredient drug product component of pharmacist services less than the national average drug acquisition cost or, if the national average drug acquisition cost is unavailable, the wholesale acquisition cost; or
(iii) making or allowing any reduction of payment for pharmacist services by a PBM or a healthcare insurer directly or indirectly to a pharmacy under a reconciliation process to an effective rate of reimbursement, including without limitation generic effective rates, brand effective rates, direct and indirect remuneration fees, or any other reduction or aggregate reduction of payment. A claim or aggregate of claims for pharmacist services shall not be directly or indirectly retroactively denied or reduced after adjudication of the claim or aggregate of claims unless:

(i) a fraud claim was originally submitted;
(ii) original claim payment was incorrect because the pharmacy or pharmacist had already been paid for the pharmacist services; or
(iii) improper pharmacist services were rendered by the pharmacy or pharmacist.

Link to Existing Law: AR ST § 23-92-506

PRACTICAL NOTE

This is a standard clawback law and prohibits retrospective DIR fees. However, it must be noted that these requirements are limited to insurance plans regulated by the State, and would exclude Medicare Part D, TRICARE, and possibly ERISA-regulated plans.* *In the case PCMA v. Rutledge, 891 F.3d 1109 (8th Cir. 2018), the court held that such laws are preempted by Medicare Part D and ERISA. Arkansas challeneged only the portion of the holding pertaining to ERISA, and that challenge is fully briefed and pending argument in October 2020 before the Supreme Court of the United States. Therefore, in Eighth Circuit states, the law is that Medicare Part D and ERISA preempt state law as to DIR fees, but these holdings are in flux.