SB 1225 — pharmacies; cost sharing requirement; rebates

Bill Text

• Introduced Introduced Version Current pdf

AI-generated reading aid from the bill's amendatory text — verify against the official bill.

This bill establishes new requirements for pharmacy benefit managers and third-party payors regarding cost sharing for prescription drugs.

• Title 20, chapter 25, article 2, Arizona Revised Statutes

  20-3337. Pharmacy benefit managers; third-party payors; cost sharing requirement; prescription drugs A. A PHARMACY BENEFIT MANAGER OR A THIRD-PARTY PAYOR SHALL REQUIRE THAT A COVERED INDIVIDUAL'S COST SHARING REQUIREMENT FOR A PRESCRIPTION DRUG BE CALCULATED AT THE POINT OF SALE BASED ON A PRICE THAT IS REDUCED BY AN AMOUNT EQUAL TO AT LEAST ONE HUNDRED PERCENT OF ALL REBATES THAT ARE RECEIVED BY THE PHARMACY BENEFIT MANAGER OR THIRD-PARTY PAYOR FOR THE PRESCRIPTION DRUG. B. A PHARMACY BENEFIT MANAGER OR THIRD-PARTY PAYOR MAY NOT RETAIN ANY PORTION OF A REBATE OR OTHER PRICE CONCESSION AS A SOURCE OF REVENUE. C. THIS SECTION DOES NOT PREVENT A PHARMACY BENEFIT MANAGER OR THIRD-PARTY PAYOR FROM DECREASING A COVERED INDIVIDUAL'S COST SHARING REQUIREMENT BY AN AMOUNT GREATER THAN WHAT IS REQUIRED IN SUBSECTION A OF THIS SECTION.

  The bill introduces a new requirement that cost sharing for prescription drugs must be based on rebates received, preventing benefit managers from retaining any part of those rebates.

• Title 20, chapter 25, article 2, Arizona Revised Statutes

  D. FOR THE PURPOSES OF THIS SECTION: 1. "COST SHARING REQUIREMENT" MEANS ANY COPAYMENT, COINSURANCE, DEDUCTIBLE OR OTHER COVERED INDIVIDUAL OBLIGATION FOR A COVERED PRESCRIPTION DRUG. 2. "COVERED INDIVIDUAL" MEANS AN INSURED, ENROLLEE OR SUBSCRIBER WHO IS ELIGIBLE TO RECEIVE BENEFITS THROUGH A HEALTH CARE PLAN AS DEFINED IN SECTION 20-3335. 3. "REBATE" MEANS: (a) NEGOTIATED PRICE CONCESSIONS, INCLUDING BASE PRICE CONCESSIONS AND REASONABLE ESTIMATES OR ANY PRICE PROTECTION REBATES AND PERFORMANCE-BASED REBATES, THAT MAY ACCRUE DIRECTLY OR INDIRECTLY TO THE PHARMACY BENEFIT MANAGER OR THIRD-PARTY PAYOR DURING THE COVERAGE YEAR FROM A MANUFACTURER, DISPENSING PHARMACY OR OTHER PARTY IN CONNECTION WITH DISPENSING THE PRESCRIPTION DRUG. (b) ADMINISTRATION FEES AND OTHER PAYMENTS THAT ARE COLLECTED BY THE PHARMACY BENEFIT MANAGER OR THIRD-PARTY PAYOR FROM A MANUFACTURER.

  Definitions are provided for key terms, enhancing clarity around cost sharing requirements, covered individuals, and what constitutes a rebate.

Action History

1. January 21, 2026

   Senate Second Reading

2. January 20, 2026

   Senate First Reading

Sponsors

• Brian Fernandez · Primary

Subjects