Arkansas insurance officials defend Rule 128 to gather PBM data and potentially require dispensing fees

The Arkansas Insurance Department presented proposed Rule 128 to the Senate Insurance & Commerce Committee, saying the rule would require health plans and PBMs to submit prior‑year pharmacy reimbursement statistics and dispensing‑fee data so the department can evaluate whether pharmacies are being paid at levels necessary to preserve an adequate pharmacy network.

"We were receiving about 7 to 10 emails or letters a day," Booth Rand, general counsel for the Insurance Department, told the committee, describing an influx of pharmacy complaints this spring and summer that prompted the rulemaking. The department said it will review each health plan individually and may require a dispensing‑cost addition when the data indicate current reimbursements are not "fair and reasonable."

Why it matters: supporters say the rule gives the department a standardized way to test whether market reimbursements are pushing independent pharmacies out of networks and to set remedies before network adequacy declines. Opponents — including multiple legislators at the hearing — warned a required dispensing fee would likely be reflected in higher premiums or higher point‑of‑sale costs for patients.

What the rule would require and how it would work

The bulletin attached to Rule 128 asks plans to supply statistics such as the average percentage a plan reimburses above NAADAC (the National Average Drug Acquisition Cost), the average dispensing fee currently paid, total drug claims and pharmacy network retention figures. Rand said plans must provide data…