ARM 6.6.7903. NETWORK ADEQUACY REPORTING

(1) A PBM must submit the following reports and information for each pharmacy network as part of its license or license renewal application to demonstrate to the commissioner a sufficient and adequate pharmacy network: (a) a report in a form and in a manner prescribed by the commissioner that designates the number and location of all retail pharmacies, mail-order pharmacies, and specialty pharmacies, if any, in each pharmacy network; (b) a network accessibility report that includes: (i) the access standard or standards the PBM establishes to determine network adequacy based on the number of miles between an enrollee or an injured worker of a workers' compensation insurance carrier and nearest retail pharmacy in the pharmacy network; (ii) the number of enrollees or injured workers of a workers' compensation insurance carrier with access to a retail pharmacy in the pharmacy network using the access standard established by the PBM; (iii) the average number of miles between the enrollees and injured workers of a workers' compensation insurance carrier identified in (ii) and the nearest retail pharmacy in the pharmacy network; (iv) the number of enrollees and injured workers of a workers' compensation insurance carrier without access to a retail pharmacy in the pharmacy network using the access standard established by the PBM; (v) the average number of miles between the enrollees and injured workers of a workers' compensation insurance carrier identified in (iv) and the nearest retail pharmacy in the pharmacy network; and (vi) the ratios of retail pharmacies in the pharmacy network to an enrollee or an injured worker of a workers' compensation insurance carrier; and (c) the PBM's process for monitoring and ensuring on an ongoing basis a sufficient and adequate pharmacy network to meet the pharmacist services needs of enrollees and injured workers of a workers' compensation insurance carrier. (2) A PBM must file and update the report required in (1)(a) with the commissioner if the number of pharmacies in the pharmacy network decreases by more than 5% during the year.