A federal appeals court is expected to rule in the coming days on a challenge to an Arkansas law regarding discounts for prescription drugs. Act 1103 requires drug makers to comply with a federal program ensuring discounts for clinics and pharmacies serving rural and low-income communities. Arkansas became the first state in the nation to pass a law of that type in 2021. However, PBMs have sought to undermine the law since its inception. The Pharmaceutical Research and Manufacturers of America are seeking to overturn Arkansas’ law, while Community Health Centers of Arkansas and the state Insurance Department are arguing in favor of keeping the Arkansas law in place. A federal judge upheld the law late last year. The 8th Circuit U.S. Court of Appeals heard oral arguments in the case last week and could issue a ruling in the coming days.

Arkansas Gov. Sarah Huckabee Sanders (R) signed SB 94 into law, legislation that creates greater enforcement of PBM laws through the Office of the Insurance Commissioner. The commissioner is now empowered to review the books and records of PBMs regarding drug rebates and payment to pharmacies for products and services. The commissioner may now also issue fines for a range of violations, including under-reimbursement.

Gov. Sarah Huckabee Sanders (R) recently signed SB 94, which creates greater enforcement of PBM laws through the Office of the Insurance Commissioner. The commissioner is now empowered to review the books and records of PBMs regarding drug rebates and payment to pharmacies for products and services. The commissioner may now also issue fines for a range of violations, including under-reimbursement.

The Arkansas House of Representatives proposed a bill that would amend the Pharmacy Practice Act to restrict pharmacy ownership to certain individuals and entities. The bill would require an applicant for a pharmacy permit to provide proof that the owner is one of the following: 1. an Arkansas licensed pharmacist, 2. a partnership in which each active member is an Arkansas licensed pharmacist, 3. a corporation or association in which the majority stock is owned by Arkansas licensed pharmacists, or 4. a limited liability company in which the majority membership interests are owned by Arkansas licensed pharmacists who are employed in and responsible for the management, supervision, and operation of the pharmacy. If enacted, this bill will create significant market entry barriers for all nonresident pharmacies and entities and pharmacists not licensed by the Arkansas board.

In what is being hailed as a major victory for community health centers and their patients, a federal judge has upheld a state law that requires pharmaceutical manufacturers to provide access to discounted drugs to contract pharmacies in the state under the 340B Drug Pricing Program. U.S. District Judge Billy Roy Wilson issued an order this week rejecting the first of two constitutional challenges by the pharmaceutical industry regarding Act 1103 of 2021. Arkansas Act 1103 of 2021 — the 340B Drug Pricing Nondiscrimination Act — requires drug manufacturers to provide 340B pricing to any Arkansas pharmacies that enter into contractual agreements with entities covered under 340B, regardless of whether those pharmacies are in-house or third-party pharmacies contracting services to providers. The state law is the first of its kind nationally.

In a recently released bulletin, the Arkansas Insurance Commissioner made clear that PBMs are prohibited from charging pharmacies fees related to network participation, including pharmacy credentialing or re-credentialing fees. The bulletin comes after Arkansas pharmacists reported receiving additional fees from PBMs, many of which were unapproved. In response, the Commissioner sent out the bulletin and “advise[d] the PBM industry that the Department will begin enforcement against unapproved fees.”

The State of Arkansas is suing drugmakers and pharmacy benefit managers for colluding to drive up the price of insulin drugs. The lawsuit targets Eli Lilly, Novo Nordisk, and Sanofi, which make up the vast majority of insulin drugs sold in the United States. It also takes aim at PBMs like UnitedHealth Group Inc’s Optum unit, CVS Corp’s Caremark, and Cigna Corp’s Express Scripts. The lawsuit comes after Eli Lilly raised the price of its Humalog 1,219%, Novo Nordisk raised the price of NovoLog 627%, and Sanofi raised the price of Lantus by 715% since they launched.

The Arkansas Department of Insurance is holding pharmacy benefit managers (PBMs) accountable for their deceptive actions. The Department has issued a bulletin putting PBMs on notice that denial of Maximum Allowable Cost (MAC) appeals when a pharmacy's reimbursement is below acquisition costs will cause these PBMs to be subject to fines under the Arkansas Deceptive Trade Practices Act.

HB 1881 was passed into law in order to protect patient choice by prohibiting a PBM from mandating that a patient use a mail-order pharmacy or interfering with the patient's right to choose an in-network pharmacy of their choice. It also prohibits a PBM from discriminating against 340B entities through lower reimbursements or exclusion from provider networks.

SB 617 has been signed into law and now become Act 1053. This Act now requires written consent from a patient before transfer prescriptions to a new pharmacy, in order to prevent PBM-owned pharmacies from steering patients and filling prescriptions without express consent. It also requires this pharmacy to disclose the conflict of interest due to its PBM relation, and prohibits the pharmacy from data mining and using patient data for solicitation purposes.

HB 1852 has been signed into law by Governor Hutchinson in order to set standards for prescription delivery. This law prohibits a PBM-owned pharmacy (or other similar entity) from requiring that their patients have to receive prescriptions through home-delivery services.

Changes were made to The Arkansas Pharmacy Audit Bill Of Rights and The Arkansas Pharmacy Benefits Manager Licensure Act in order to reflect the unanimous decision made in the landmark case, Rutledge v. PCMA. This grants the Insurance Department enforcement authority over existing fair pharmacy audit laws.

HB 1134 has been passed into law, and this allows pharmacists in the state to prescribe, administer, deliver, distribute, or dispense vaccines - as well as any medications to treat any adverse reactions to the vaccines - to any patients 3 years and older. This is an important step in achieving recognition and provider status for Arkansas pharmacists.

In their decision on Rutledge v PCMA, the Supreme Court ruled in favor of Arkansas Act 900 and independent pharmacies across the country. The ruling determines that states have the right to regulate pharmacy benefit managers (PBMs) in managed care organizations. It also prohibits PBMs from reimbursing pharmacies at a lower rate than what the pharmacies pay to fill prescriptions