Overview
Arizona is active in promoting price transparency in health care. The state has some protections in place that address surprise billing for emergency services and services from out-of-network providers. This includes creating a solution for settling payment disputes between out-of-network providers and insurers by limiting patients’ liability and allowing for arbitration to settle disputes.
In a push for greater drug pricing transparency and lower drug costs, the state legislature unanimously passed the Prescription Drug Pricing Patient Protection Act in 2018. This act includes prohibitions on “gag clauses” that restrict pharmacies from informing customers about available alternative pricing for medications, as well as on co-pay “clawbacks,” where insured patients’ copayments exceed the total cost of the drug to their insurer or pharmacy benefit manager.
In addition to promoting price transparency, Arizona monitors consolidation in the health care market by requiring nonprofit health care entities to provide notice to the Attorney General of all impending health care transactions with other nonprofit or for-profit entities.
Meanwhile, in 2024 Arizona enacted legislation related to medical review, reimbursements, and appeal procedures, including specific processes for appealing denied claims or services as well as outlining the roles of healthcare insurers and other entities responsible for performing reviews and dealing with appeals.
See below for an overview of existing Arizona state mandates. Click on citation tab for detailed information of specific statutes (click link to download statute text).
State Action
Latest Legislative Session: 1/9/2023 - 4/22/2023 (2023 term). *Current session bill updates are ongoing. Check back weekly for updates.
HB 1268 – Arizona
Introduced: 2020 Status: Inactive / Dead
Health care insurance; hearing aids: The department shall annually establish minimum coverage rates and coverage limits for adult and child hearing aids for each deaf or hard of hearing ear that would allow for at …
HB 2045 – Arizona
Introduced: 2020 Status: Inactive / Dead
Correctional health services; prohibited contracts: notwithstanding any other law, beginning from and after June 30, 2021, the department shall administer all correctional health care services and may not enter into a contract with a private …
HB 2083 – Arizona
Introduced: 2018 Status: Enacted
RELATING TO INSURANCE CONTRACTS: Amends Rev. Stat. Ann. § 20-1119, which requires every insurance contract to be construed according to the entirety of its terms and conditions as set forth in the policy and as …
HB 2104 – Arizona
Introduced: 2021 Status: Inactive / Dead
An Act requiring a report from the director of the department of insurance and financial institutions on surprise billing.
HB 2112 – Arizona
Introduced: 2023 Status: Inactive / Dead
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 …
Ariz. Rev. Stat. § 20-1057.14. Cancer treatment medications; cost sharing; definition: Health Care Services Organizations – Arizona
Introduced: Status: Enacted
An evidence of coverage that is issued, delivered or renewed by a health care services organization on or after January 1, 2016 and that provides coverage both for cancer treatment medications that are injected or …
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Ariz. Rev. Stat. § 20-1057.17. Coverage of health care services: Health Care Services Organizations – Arizona
Introduced: Status: Enacted
Any evidence of coverage issued, delivered or renewed on or after July 1, 2017 by a health care services organization in this state must provide coverage for lawful health care services that are provided by …
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Ariz. Rev. Stat. § 20-1061. Prohibited Practices; Definition: Health Care Service Organizations – Arizona
Introduced: Status: Enacted
Chapter 2, article 6 of this title relating to unfair trade practices and frauds applies to health care services organizations, except to the extent the director determines that the nature of health care services organizations …
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Ariz. Rev. Stat. § 20-1069.01. Right to open enrollment period; enrollees; definitions: Health Care Services Organizations – Arizona
Introduced: Status: Enacted
Managed Care Accountability Act: Statute makes numerous changes to statutes governing managed health care plans relating to health care services oversight, the medical decision making process, medical directors, standing referrals, the expedited review process, prescription …
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Ariz. Rev. Stat. § 20-1070. Acquisitions and Mergers: Health Care Service Organizations – Arizona
Introduced: Status: Enacted
No health care services organization may merge with another foreign or domestic health care services organization or may be acquired by a person except on approval by the director and by complying with the provisions …
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In Re: Generic Pharmaceuticals Pricing Antitrust Litigation – Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin
District Court: Eastern District of Pennsylvania Status: Pending
Plaintiffs are attorney generals from 48 states, Puerto Rico, and the District of Columbia, as well as classes of private plaintiffs that filed an antitrust …
Additional Resources
STATE BUDGET
Arizona has an annual budget cycle; the fiscal year beginning on July 1. State agencies submit budget requests to the Governor by September 1, the Governor submits the proposed budget to the legislature five days after the Legislature convenes. There is no deadline for the Legislature to pass the budget. The Governor has line item veto authority. The Governor is required to submit a balanced budget to the Legislature, but the Legislature is not required to pass a balanced budget.
STATE LEGISLATURE
There are 30 state Senators, and the House of Representatives has 60 members. Both House and Senate serve two-year terms. Arizona has term limits, with Senators and Representatives only allowed to serve for four consecutive terms (or eight years) in each chamber. After a two-year break, former members are eligible for election again. Regular Session starts on the second Monday in January, and is scheduled to last for 100 days, however the House and Senate can mutually vote to extend the Regular Session beyond the 100 days. Bills do not carry over from year to year.