Official Summary Text
HB2813 - 572R - House Bill Summary
ARIZONA HOUSE OF REPRESENTATIVES
57th
Legislature, 2nd Regular Session
Majority Research Staff
HB
2813
: pharmacy benefits; workers' compensation
Sponsor:
Representative Livingston, LD 28
Committee
on Appropriations
Overview
Effective
January 1, 2027, provides regulations authorizing an employer or insurer to
contract with a formal pharmacy management network (pharmacy network) to
provide necessary medications to injured employees.
History
Promptly, on notice to the employer, every injured
employee must receive medical, surgical and hospital benefits or other
treatment, nursing, medicine, surgical supplies, crutches and other apparatus,
including artificial members, reasonably required at the time of the injury,
and during the period of disability. Such benefits must be termed
"medical,
surgical and hospital benefits."
Compensation for medical, surgical and hospital
benefits must include reimbursement for reasonable travel expenses if the
employee must travel more than 25 miles from the employee's place of
residence to obtain medical care for the injury (A.R.S. �
23-1062
).
Provisions
1.
Allows an
employer or insurer to establish or contract with a pharmacy network to provide
necessary medications to injured employees. (Sec. 1)
2.
Allows a pharmacy
network to contract for reimbursement amounts that are different from the fee
schedule established by the Industrial Commission (Commission). (Sec. 1)
3.
Prohibits a pharmacy
network from reimbursing a pharmacy provider for an amount that is less than
the pharmacy's actual cost of the medication for the injured employee plus the
dispensing fee established by the Commission. (Sec. 1)
4.
Specifies a
pharmacy services administrative organization is not considered an employer's
formal pharmacy network or an agent of a contract pharmacy or dispensing
provider. (Sec. 1)
5.
Allows an
informal, voluntary pharmacy network to be used by an injured employee on a
voluntary basis and is not subject to the network requirements. (Sec. 1)
6.
Requires an
employer or insurer that establishes a pharmacy network to notify employees by
posting a notice in a prominent location at the workplace or provide the
information in hardcopy or by electronic means that employees may use and how
to fill a prescription. (Sec. 1)
7.
Requires an
employer or insurer that establishes a pharmacy network to notify the employee,
at the time of a reported injury, on how to use the pharmacy network and
provide a list of participating network pharmacies and providers in hardcopy or
by electronic means. (Sec. 1)
8.
Requires
out-of-network prescriptions from retail pharmacies or dispensing providers for
medications that are reasonably required for the period of disability and are
related to compensable claim to be reimbursed at the pharmacy fee schedule
amount established by the Commission until the payor or formal pharmacy network
provides the out-of-network pharmacy or dispensing provider a notice, as
outlined. (Sec. 1)
9.
Requires a
pharmacy network to accept as part of the formal network any pharmacy or
dispensing provider that is licensed and in good standing and willing to abide
by the formal pharmacy network's contract terms. (Sec. 1)
10.
Requires a
pharmacy network to register with the Commission and submit a form as
prescribed by the Commission and pay a registration fee in an amount
established by the Commission in rule. (Sec. 1)
11.
Requires a
pharmacy network to provide a timely process for pharmacies and dispensing
providers to dispute a denial or amount of reimbursement of a pharmaceutical
bill.������ �(Sec. 1)
12.
Requires a
pharmacy network to perform audits of pharmacies and dispensing providers. (Sec.
1)
13.
Prohibits a
pharmacy network or a contracted network from charging pharmacies or dispensing
providers for any direct or indirect fees associated with dispensing,
processing or billing of a prescription drug or medication that is dispensed to
an injured employee or any fee related to the enrollment or annual reenrollment
of the pharmacy in the network or credentialing. (Sec. 1)
14.
Directs a
pharmacy processing agent or third-party biller that accepts the assignment of
bills from a pharmacy or dispensing provider that is contracted with the
pharmacy network to be reimbursed at the contractual amount agreed to by the
assigning pharmacy or dispensing provider. �(Sec. 1)
15.
Specifies
that an injured employee is not required to use a pharmacy or dispensing
provider in the pharmacy network until the claim dispute is resolved and it
provides notice to the parties that the claim is accepted. (Sec. 1)
16.
Requires the
injured employee to obtain medications through the pharmacy network. (Sec. 1)
17.
Exempts a
pharmacy network that is registered in Arizona and provides pharmacy services
from statutes relating to pharmacy benefit managers. (Sec. 1)
18.
Allows the
Commission to adopt rules necessary to implement the pharmacy network
requirements. (Sec. 1)
19.
Specifies
that employers do not include a self-insured employer that elects to provide
medical care. (Sec. 1)
20.
Contains an
effective date of January 1, 2027. (Sec. 2)
21.
22.
23.
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24.
Initials AG/LK��������������� HB
2813
25.
2/16/2026� Page 0 Appropriations
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Current Bill Text
Read the full stored bill text
HB2813 - 572R - I Ver
REFERENCE TITLE:
pharmacy benefits; workers' compensation
State of Arizona
House of Representatives
Fifty-seventh Legislature
Second Regular Session
2026
HB 2813
Introduced by
Representative
Livingston
AN
ACT
amending title 23, chapter 6, article 9,
arizona revised statutes, by adding section 23-1062.04; relating to
workers' compensation.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Title 23, chapter 6, article 9,
Arizona Revised Statutes, is amended by adding section 23-1062.04, to read:
START_STATUTE
23-1062.04.
Pharmacy benefits; pharmacy management network; notice;
registration; fees; disputes; rules
A. An employer or insurer may
establish or contract with a formal pharmacy management network to provide
necessary medications to injured employees.
B. A formal pharmacy management
network may contract for reimbursement amounts that are different from the fee
schedule established by the commission pursuant to section 23-908.�
C. A formal pharmacy management
network may not reimburse a pharmacy provider for an amount that is less than
the pharmacy's actual cost of the medication ordered for the injured employee
plus the dispensing fee established by the commission.
D. For the purposes of this section,
a pharmacy services administrative organization is not considered an employer's
formal pharmacy management network or an agent of a contract pharmacy or
dispensing provider.
E. An informal, voluntary pharmacy
management network may be used by an injured employee on a voluntary basis and
is not subject to this section.
F. An employer or insurer that
establishes a formal pharmacy management network shall do both of the
following:
1. When an employer or insurer
initially establishes the formal pharmacy management network, the employer or
the insurer shall notify employees by posting a notice in a prominent location
at the workplace or by providing the information in hardcopy or by electronic
means that employees may use the pharmacy management network and how to fill a
prescription.
2. At the time of a reported injury,
notify the employee on how to use the formal pharmacy management network and
provide a list of participating network pharmacies and providers in hardcopy or
by electronic means.
G. Out-of-network
prescriptions from retail pharmacies or dispensing providers for medications
that are reasonably required for the period of disability and that are related
to a compensable claim shall be reimbursed at the pharmacy fee schedule amount
established by the commission UNTIL the payor or formal pharmacy management
network provides to the out-of-network pharmacy or dispensing
provider a notice that contains all of the following:
1. Notice that the injured employee
is required to receive prescriptions from a pharmacy or dispensing provider
that participates in the established formal pharmacy management network.
2. Notice that future medication
refills by the out-of-network pharmacy or dispensing provider will
not be reimbursed.
3. An invitation to the pharmacy or
dispensing provider to join the formal pharmacy management network, if desired.
H. A formal pharmacy management
network shall accept as part of the formal pharmacy management network any
pharmacy or dispensing provider that is licensed and in good standing and is
willing to abide by the formal pharmacy management network's contract terms.
I. A formal pharmacy management
network shall register with the commission and submit a form as prescribed by
the commission.� A formal pharmacy management network shall pay a registration
fee in an amount established by the commission in rule.
J. A formal pharmacy management
network shall provide a timely process for pharmacies and dispensing providers
to dispute a denial or amount of reimbursement of a pharmaceutical bill.
K. A formal pharmacy management
network or a contracted formal pharmacy management network shall perform audits
of pharmacies and dispensing providers.
L. A formal pharmacy management
network or a contracted formal pharmacy management network may not charge
pharmacies or dispensing providers for any direct or indirect fees associated
with dispensing, processing or billing of a prescription drug or medication
that is dispensed to an injured employee or any fee related to the enrollment
or annual reenrollment of the pharmacy in the network or credentialing.
M. A pharmacy processing agent or
third-party biller that accepts the assignment of bills from a pharmacy
or dispensing provider that is contracted with a formal pharmacy management
network must be reimbursed at the contractual amount agreed to by the assigning
pharmacy or dispensing provider.
N. If a claim is disputed for
compensability, an injured employee is not required to use a pharmacy or
dispensing provider in the formal pharmacy management network until the claim
dispute is resolved and the formal pharmacy management network provides notice
to the parties that the claim is accepted.� The injured employee is required to
obtain medications through the formal pharmacy management network.
O. A formal pharmacy management
network that is registered with this state and provides pharmacy services under
this section is exempt from title 20, chapter 25, article 2.
P. The commission may adopt rules
necessary to implement the REQUIREMENTS of this section.
Q. For the purposes of this section,
employer does not include a self-insured employer that elects to provide
medical care pursuant to section 23-1070.
END_STATUTE
Sec. 2.
Effective date
Section 23-1062.04, Arizona
Revised Statutes, as added by this act, is effective from and after December
31, 2026.