As used in this part:

1. (1) “Adverse impact” means the:

   1. (A) Participation of pharmacies is reduced by ten percent (10%) or more within the distance compliance requirements as specified in 23 CAR § 146-106(b); and
   2. (B) Reduction in participation is solely due to a reduction in the compensation or reimbursement to a pharmacy;

2. (2) "Claims processing services" means the administrative services performed in connection with the processing and adjudicating of claims relating to pharmacist services that include:

   1. (A) Receiving payments for pharmacist services;
   2. (B) Making payments to pharmacists or pharmacies for pharmacist services; or
   3. (C) Both subdivisions (2)(A) and (B) of this section;
3. (3) "Commissioner" means the Arkansas Insurance Commissioner;
4. (4) "Department" means the State Insurance Department;

5. (5)

   1. (A) "Health benefit plan" means any individual, blanket, or group plan, policy, or contract for healthcare services issued or delivered by a healthcare payor to residents of this state, including any group plan, policy, or contract for healthcare services issued outside this state that provide benefits to residents of this state.

   2. (B) "Health benefit plan" does not include:

      1. (i) Accidental-only plans;
      2. (ii) Specified disease plans;
      3. (iii) Disability income plans;
      4. (iv) Plans that provide only for indemnity for hospital confinement;
      5. (v) Long-term care only plans that do not include pharmacy benefits;
      6. (vi) Other limited-benefit health insurance policies plans; or

      7. (vii) Health benefit plans provided under:

         1. (a) (a) Arkansas Constitution, Article 5, § 32;
         2. (b) (b) The Workers' Compensation Law, Arkansas Code § 11-9-101 et seq.; and
      8. (c) (c) The Public Employee Workers' Compensation Act, Arkansas Code § 21-5-601 et seq.; and

      9. (viii)

         1. (a) (a) Medicare Advantage plans or Medicare programs which provide pharmacy or prescription drug coverage.
         2. (b) (b) However, to the extent as permitted under federal law, such plans shall be included within the definition of health benefit plan, if the United States Supreme Court, or in the absence of such a ruling, the Eighth Circuit Court of Appeals, rules that such plans are subject to state regulation, with such regulation specific only to the authorities granted by the ruling court.
      10. (c) (c) Should such a ruling occur and these plans become subject to regulation by the State Insurance Department, the State Insurance Department shall enforce any applicable law or regulation only against plans managed pursuant to contracts executed after the effective date of such ruling;

6. (6) "Healthcare insurer" means:

   1. (A) An insurance company;
   2. (B) A health maintenance organization; or
   3. (C) A hospital and medical service corporation;
7. (7) “Healthcare payor” means “healthcare payor” as defined by Arkansas Code § 23-92-503(3);
8. (8) "Maximum allowable cost (“MAC”) law" or "MAC law" shall mean the requirements of Arkansas Code § 17-92-507 for PBMs that are administering pharmacy benefits for a health benefit plan of a healthcare insurer;

9. (9) "Other prescription drug or device services" means services other than claims processing services, provided directly or indirectly, whether in connection with or separate from claims processing services, including without limitation:

   1. (A) Negotiating rebates, discounts, or other financial incentives and arrangements with drug companies;
   2. (B) Disbursing or distributing rebates;
   3. (C) Managing or participating in incentive programs or arrangements for pharmacist services;
   4. (D) Negotiating or entering into contractual arrangements with pharmacists or pharmacies, or both;
   5. (E) Developing formularies;
   6. (F) Designing prescription benefit programs; or
   7. (G) Advertising or promoting services;
10. (10) “Pass-through pricing” means the model of prescription drug pricing in which a PBM charges the health benefit plan the amount it actually pays a pharmacy for prescription drug or device services plus an administrative fee charged on a per-prescription or per-member basis;
11. (11) "PBM affiliate" means a pharmacy or pharmacist that directly or indirectly, through one (1) or more intermediaries, owns or controls, is owned or controlled by, or is under common ownership or control with a pharmacy benefits manager;
12. (12) "PBM network" means a network of pharmacists or pharmacies that are offered by an agreement or insurance contract to provide pharmacist services for health benefit plans;
13. (13) "Pharmacist" means an individual licensed as a pharmacist by the Arkansas State Board of Pharmacy;
14. (14) "Pharmacist services" means products, goods, and services, or any combination of products, goods, and services, provided as a part of the practice of pharmacy as defined in Arkansas Code § 17-92-101;
15. (15) “Pharmacy" means the same as defined in Arkansas Code § 17-92-101;

16. (16)

    1. (A) "Pharmacy benefits manager" or "PBM" means a person, business, or entity, including a wholly or partially owned or controlled subsidiary of a PBM, that provides claims processing services or other prescription drug or device services, or both, for health benefit plans.

    2. (B) "Pharmacy benefits manager" does not include any:

       1. (i) Healthcare facility licensed in Arkansas;
       2. (ii) Healthcare professional licensed in Arkansas;
       3. (iii) Consultant who only provides advice as to the selection or performance of a PBM; or
       4. (iv) Entity that provides claims processing services or other prescription drug or device services for the fee-for-service Arkansas Medicaid Program only in that capacity;
17. (17) "Pharmacy benefits plan or program" means a plan or program that pays for, reimburses, covers the cost of, or otherwise provides for pharmacist services under a health benefit plan;
18. (18) "Pharmacy services administrative organization" or "PSAO" means an organization that helps community pharmacies and PBMs or third-party payors achieve administrative efficiencies, including contracting and payment efficiencies;

19. (19)

    1. (A) "Rebate" means a discount or other price concession based on utilization of a prescription drug that is paid by a manufacturer or third party, directly or indirectly, to a PBM, pharmacy services administrative organization, or pharmacy after a claim has been processed and paid at a pharmacy.
    2. (B) "Rebate" includes without limitation incentives, disbursements, and reasonable estimates of a volume-based discount;
20. (20) "Rule 106" means Network Adequacy Requirements for Health Benefit Plans, 23 CAR pt. 137;
21. (21) "Spread pricing" means the model of prescription drug pricing in which the PBM charges a health benefit plan a contracted price for prescription drugs although the contracted price may differ with the amount the PBM pays the pharmacy; and
22. (22) "Third party" means a person, business, or entity other than a PBM that is not an enrollee or insured in a health benefit plan.