23 CAR § 146-109
23 CAR § 146-109. MAC recordkeeping requirements
Length: 266 wordsOfficial source
(a) The provisions of this section shall apply to healthcare insurers and healthcare payors as defined in Arkansas Code § 23-92-503(2) and (3), and PBMs administrating for such health benefit plans, to the extent as permitted by federal law.
(b) The following provisions of this section shall apply to any PBM subject to Arkansas Code § 17-92-507 (hereafter, the "MAC law") that administers pharmacy benefits for a health benefit plan of a healthcare insurer.
(c) To reasonably ensure compliance with the MAC law, a PBM subject to this section shall develop a recordkeeping system to track, monitor, and record the following information, to be aggregated on a quarterly basis, for the purpose of providing information to the State Insurance Department, upon request by the department:
(1) The number of challenges or appeals the PBM received under the MAC law;
(2) The outcomes of the challenge or appeal, whether denied or upheld by the PBM;
(3) The number of times the PBM provided pricing information pursuant to Arkansas Code § 17-92-507(c)(4)(C)(ii) to a challenging pharmacy to demonstrate a drug subject to appeal could be acquired from a national or regional pharmaceutical wholesaler in stock at a price below the MAC list; and
(4) The total amount of reimbursement readjustment that occurred that quarter under Arkansas Code § 17-92-507(c)(4)(C)(iii) and the average time period taken for such reimbursement adjustments.
(d) The report shall report aggregate numbers on a quarterly basis, and if submitted upon request by the department, shall be considered a request for information under Arkansas Code § 23-61-103(d) and § 23-61-207, and shall be considered confidential.