Removes the requirement that health professional groups proposing to increase the scope of practice of a state-regulated health profession must complete a statutory sunrise review

An act amending Title 36, Arizona revised statutes, by adding chapter 42; relating to prescription drugs.
Defines unconscionable increase to mean that an increase in the price of a prescription drug that both: (a) Is excessive and not justified by the cost of producing the drug or the cost of appropriate expansion of access to the drug to promote public health. And (b) Results in consumers for whom the drug has been prescribed having no meaningful choice about whether to purchase the drug at an excessive price because of the importance of the drug to the consumer’s health and insufficient competition in the market for the drug. Requires the State Medical Assistance Program to notify the Attorney General for certain price increases and creates remedies for manufacturers or wholesale distributors that violate this statute

A health care facility with more than fifty inpatient beds must make available on request or online the direct pay price for at least the fifty most used diagnosis-related group codes, if applicable, for the facility and at least the fifty most used outpatient service codes, if applicable, for the facility. The services may be identified by a common procedural terminology code or by a plain-English description. The health care facility must update the direct pay prices at least annually based on the services from a twelve-month period that occurred within the eighteen-month period preceding the annual update. The direct pay price must be for the standard treatment provided for the service and may include the cost of treatment for complications or exceptional treatment. A health care facility with fifty or fewer inpatient beds must make available on request or online the direct pay price for at least the thirty-five most used diagnosis-related group codes, if applicable, for the facility and at least the thirty-five most used outpatient service codes if applicable, for the facility. The services may be identified by a common procedural terminology code or by a plain-English description. The health care facility must update the direct pay prices at least annually based on the services from a twelve-month period that occurred within the eighteen-month period preceding the annual update. The direct pay price must be for the standard treatment provided for the service and may include the cost of treatment for complications or exceptional treatment.

Establishing a Prescription drug affordability board, setting cost affordability review and upper payment limits, requiring annual report and study.

A resolution supporting a national Medicare For All system of health care coverage.

Right To Shop Act of 2022: Establish a comparable health care service incentive program that includes an interactive mechanism on its publicly accessible website or a toll-free telephone number that enables an enrollee to request and obtain from the health insurer information on the payments made by the health insurer to network health care facilities or health care providers for comparable health care services as well as quality data for those health care facilities or health care providers to the extent available. The interactive mechanism or toll-free telephone number shall allow an enrollee seeking information about the cost of a particular health care service to compare allowed amounts among network health care facilities or health care providers, estimate out-of-pocket costs applicable to the enrollee’s health care plan and learn the average payment made to network health care facilities or health care providers for the procedure or health care service under the enrollee’s health care plan within a reasonable time frame not to exceed one year. The out-of-pocket cost estimate shall provide a good faith estimate of the amount the enrollee will be responsible to pay out of pocket for a proposed nonemergency procedure or health care service that is a medically necessary covered benefit from a health insurer’s network health care facility or health care provider, including any copayment, deductible, coinsurance or other out-of-pocket amount for any covered benefit, based on the information available to the health insurer at the time the enrollee makes the request. A health insurer may contract with a third-party vendor to satisfy the requirements of this paragraph. Requires the public report to include the concentration of health care providers in Arizona to determine whether the market is anticompetitive.

The bill would prohibit pharmacy benefit managers (PBMs) from requiring, steering, or otherwise inducing their enrollees
to utilize an “affiliated provider” or a pharmacy to receive covered prescription drugs or physician-administered drugs.
Affiliated providers include pharmacies or durable medical equipment providers in which the PBM has a direct or indirect
controlling interest.

Among other provisions, the bill would prohibit health insurers and pharmacy benefit managers (PBM) from reimbursing 340B pharmacies at rates lower than the rates they would reimburse similarly-sized non-340B pharmacies.