Effective September 20, 2024, the State of Arkansas implemented Emergency Rule 128 requiring pharmacy benefit managers (PBMs) to apply “fair and reasonable rates” to their pharmacy reimbursements. While Arkansas state law requires PBMs to use National Average Drug Acquisition Cost (NADAC) pricing for product reimbursement, the law does not address professional dispensing fees. Failing to add a dispensing fee can cause pharmacies to be reimbursed at amounts equal to or below the actual cost of filling prescriptions. The emergency rule authorizes the state Insurance Commissioner to review, and approve or deny, PBMs’ calculations of the cost to dispense prescriptions. Emergency Rule 128 includes a data filing requirement for all plans that cover Arkansas residents, including self-funded employer health plans and self-funded government health plans.

• Data filing requirements in Rule 128 apply to Arkansas issued plans or policies or resident enrollees with Arkansas licensed pharmacy reimbursements.
• Self-funded plans with fewer than 5,000 Arkansas resident covered lives are exempt from most of the data filing requirements.
• Such plans will be required to provide the total annual average percentage of total pharmacy reimbursement above or relative to NADAC pricing – or Wholesale Acquisition Cost (WAC) if NADAC is unavailable – in the previous calendar year. Plans will also be required to provide such percentage separately for generic drugs vs brand name drugs; a median and 25th/75th percent calculation for total annual above NADAC pricing; and percentages for generic and brand name drugs relative to NADAC pricing.
• Self-funded plans with partial exemption will also have to adhere to the “transition filing dates” included in the emergency rule:
  • On or before February 17, 2025 for plan year 2025
  • On or before July 1, 2025 for plan year 2026
  • On or before March 1 for subsequent plan years
• Self-funded plans with 5,000 or more Arkansas resident covered lives, as well as fully insured plans, are subject to more extensive data submission requirements outlined in Rule 128.
• A PBM may submit the filing on a plan sponsor’s behalf. Each PBM may have its own internal deadline for plan sponsors to opt in or out of having the filing submitted on their behalf. Plan sponsors should confirm with their PBM that the data will be submitted on their behalf and ensure that they are aware of any internal deadlines connected with the submission.