health insurance; pharmacy; reimbursement rates

HB 4124 requires pharmacy benefit managers (PBMs) in Arizona to reimburse local pharmacies at or above the actual acquisition cost of drugs, not below. It mandates PBMs to use specific reimbursement formulas based on national drug pricing averages, limits claim payment errors to a 2% rate, and creates a 15-day appeal process for pharmacies to challenge underpayments. The bill directly affects community pharmacies (with fewer than 10 locations) and PBMs by ensuring fair reimbursement, requiring transparent rebate disclosures, and obligating PBMs to pass manufacturer rebates to health plans for lower costs or broader coverage. Key provisions include standardized payment calculations, mandatory error correction, and annual compliance certifications to the state department.