AZ HB2196

Prohibits pharmacy benefit managers (PBMs) from reimbursing non-affiliated pharmacists or pharmacies below the actual cost paid for prescription drugs or devices, with an exception for PBMs using the same fee-for-service methodology as the state Medicaid plan.

Requires PBMs to pay pharmacies a professional dispensing fee at a rate no less than the state Medicaid fee-for-service methodology, and prohibits including this fee in drug reimbursement calculations.

Mandates PBMs include appeal procedures in pharmacy contracts, with appeals filed within seven business days of reimbursement; beginning January 1, 2027, appeal procedures must be filed with and approved by the Department of Insurance.

If a pharmacy prevails on appeal, the PBM must within seven business days adjust reimbursement, provide the national drug code, allow claim reversal and rebilling, and apply the findings to all similarly situated pharmacies reimbursed at or below the appealed rate.

Applies to contracts entered into, amended, extended, or renewed on or after December 31, 2026, and does not apply to health insurance procured by the Department of Administration for state employees.