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. The legislature also proposed a shared savings program for all health care plans in the individual and small group market, which would establish an interactive platform for comparing prices and change the way consumers select healthcare services.
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, Arizona’s continuing telemedicine efforts have put Arizona on the forefront of a nation-wide push to increase access to healthcare. While the state already had partial coverage and cost-sharing parity in place, new legislation passed in 2021 greatly expands existing telehealth laws by requiring health insurance companies to provide parity in payments – reimbursement by the health plan for telehealth services at the same or equivalent rate as paid for in-person services – for telehealth services using audio and visual features.
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 2168 – Arizona
Introduced: 2019 Status: Inactive / Dead
Pharmacies; fees; prohibition: An Act amending section 20-3321, Arizona revised statutes; amending title 20, chapter 25, Arizona revised statutes, by adding article 2; relating to pharmacy benefits, the following language: A pharmacy benefits manager, insurance …
HB 2189 – Arizona
Introduced: 2017 Status: Enacted
DISABILITY INSURANCE AND SERVICE COVERAGE: All policies issued, delivered or renewed on or after July 1, 2017 by a disability insurer in this state must provide coverage for lawful health care services that are provided …
HB 2202 – Arizona
Introduced: 2018 Status: Inactive / Dead
PHARMACY PATIENT FAIR PRACTICE ACT: A pharmacy benefits manager may not do any of the following: 1) Charge or collect from an enrollee a cost sharing requirement for a prescription or pharmacy service that exceeds the …
HB 2207 – Arizona
Introduced: 2023 Status: Inactive / Dead
To The Extent Allowed By Federal Law, A Hospital Service Corporation Or Medical Service Corporation That Issues, Amends, Delivers Or Renews A Subscription Contract On Or After The Effective Date Of This Section Shall Provide …
HB 2243 – Arizona
Introduced: 2023 Status: Inactive / Dead
Medical Service Corporation, A Hospital Service Corporation Or A Hospital, Medical, Dental And Optometric Service Corporation Shall Limit The Total Amount That A Subscriber Must Pay For A Covered Prescription Insulin Drug To Not More …
Ariz. Const. Art. 27, § 1. Regulation of ambulances; powers of legislature: Arizona Constitution – Arizona
Introduced: Status: Enacted
The legislature may provide for the regulation of ambulances and ambulance services in this state in all matters relating to services provided, routes served, response times and charges.
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Ariz. Const. Art. 27, § 2. Health care; definitions: Arizona Constitution – Arizona
Introduced: Status: Enacted
Permits a person to pay directly for healthcare services and prohibits providers from penalizing or fining a person for direct payment.
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Ariz. Rev. Stat. § 10-1817. Merger, interest exchange, conversion, domestication or division; definitions: Close Corporations – Arizona
Introduced: Status: Enacted
A domestic close corporation may be a party to or otherwise undertake a merger, an interest exchange, a conversion, a domestication or a division by complying with chapters 11 and 13 of this title and …
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Ariz. Rev. Stat. § 10-1875. Merger, interest exchange, conversion, domestication or division; definitions: Business Trusts – Arizona
Introduced: Status: Enacted
A domestic business trust may be a party to or otherwise undertake a merger, an interest exchange, a conversion, a domestication or a division by complying with chapters 11 and 13 of this title and …
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Ariz. Rev. Stat. § 10-2240. Merger, interest exchange, conversion, domestication or division; definitions: Professional Corporations – Reorganization and Termination – Arizona
Introduced: Status: Enacted
A domestic professional corporation may be a party to or otherwise undertake a merger, an interest exchange, a conversion, a domestication or a division by complying with chapters 11 and 13 of this title and …
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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
FY 2020 BUDGET
Budgets are set for a fiscal year. The fiscal year is the 12‐month period beginning on July 1 and ending June 30 of the following year. Arizona released its FY 2020 Budget on January 18, 2019. To view Arizona’s Department of Health and Welfare FY 2020 spending plan, go to pages 31-34.
REGULATION & ENFORCEMENT
- The Arizona Department of Insurance publishes the following in relation to health insurance: market conduct examination reports, regulatory bulletins, enforcement orders, and rulemaking activities.
KEY RESOURCES