AR SB520

Expands the definition of "Maximum Allowable Cost List" to include various pricing methodologies used by pharmacy benefits managers and requires drugs on such lists to be therapeutically equivalent, pharmaceutically available from state wholesalers, and not obsolete.

Establishes a 30-day administrative appeal process allowing pharmacies to challenge maximum allowable costs that don't meet requirements or fall below pharmacy acquisition costs, with pharmacy benefits managers required to respond within 30 days and either adjust prices or provide documentation.

Prohibits pharmacy benefits managers from conducting "spread pricing" (charging health plans different prices than what they pay pharmacists/pharmacies) and requires quarterly reporting to the Insurance Commissioner on rebates received, distributed, and passed to enrollees.

Prohibits pharmacy benefits managers from charging pharmacies unapproved fees, requiring inconsistent accreditation standards, reimbursing less than affiliates for the same services, or retroactively denying claims without valid cause (fraud, duplicate payment, or improper rendering).

Mandates reimbursement for prescription drug ingredients at no less than national average drug acquisition cost or wholesale acquisition cost, and extends gag clause prohibitions and licensure requirements to Medicaid Provider-Led Organized Care entities and other Medicaid managed care programs.