Current through Register Vol. 49, No. 9, September, 2024
SECTION 1.
AUTHORITY
This Rule is issued pursuant to the authority granted the
Arkansas Insurance Commissioner ("Commissioner") by Act 357 of 2021, codified
at Ark. Code Ann. §
23-79-2101 et seq., which provides the Commissioner
with authority necessary to promulgate rules to implement Act 357 of 2021,
"Arkansas Coverage for Early Refills of Prescription Eye Drops Act."
SECTION 2.
APPLICABILITY AND
SCOPE
This Rule shall apply to all entities defined by Ark. Code Ann.
§
23-79-2102 as "healthcare insurers" that provide coverage for
prescription eye drops under a health benefit plan to a covered person on and
after January 1, 2022.
SECTION
3.
DEFINITIONS
The following words and terms, when used in this Rule, shall
have the following meanings, unless the context clearly indicates
otherwise.
(1) "Covered person" means
a person who is and continues to remain eligible for coverage under a health
benefit plan and is covered under the health benefit plan.
(2)
(a)
"Health benefit plan" means:
(1) An
individual, blanket, or group plan, policy, or contract for healthcare services
issued or delivered by a healthcare insurer; and
(2) Any health benefit program receiving
state or federal appropriations from the State of Arkansas, including the
Arkansas Medicaid Program and the Arkansas Works Program, or any successor
program.
(b) "Health
benefit plan" includes:
(1) Indemnity and
managed care plans; and
(2)
Nonfederal governmental plans as defined in
29
U.S.C. §
1002(32), as
it existed on January 1, 2021.
(c) "Health benefit plan" does not include:
(1) A disability income plan;
(2) A credit insurance plan;
(3) Insurance coverage issued as a supplement
to liability insurance;
(4) A
medical payment under automobile or homeowners insurance plans;
(5) A health benefit plan provided under
Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law,
§
11-9-101 et seq.,
or the Public Employee Workers' Compensation Act, §
21-5-601 et
seq.;
(6) A plan that provides only
indemnity for hospital confinement;
(7) An accident-only plan;
(8) A specified disease plan;
(9) A long-term-care-only plan;
(10) A dental-only plan; or
(11) A vision-only plan.
(3) "Healthcare insurer" means an
entity subject to the insurance laws of this state or the jurisdiction of the
Insurance Commissioner that contracts or offers to contract to provide health
insurance coverage, including without limitation an insurance company, a health
maintenance organization, a hospital medical service corporation, a self-
insured governmental or church plan in this state, or the Arkansas Medicaid
Program.
(4) "Healthcare
professional" means a person who is licensed, certified, or otherwise
authorized by the laws of this state to administer health care in the ordinary
course of the practice of his or her profession.
(5) "Prescription eye drops" means a
prescription topical eye medication that is delivered through eye drops and is
used to treat a chronic condition of the eye.
SECTION 4.
REQUIREMENT TO PROVIDE EARLY
REFILLS OF PRESCRIPTION EYE DROPS
A healthcare insurer that provides coverage for prescription
eye drops under a health benefit plan shall provide coverage for early refills
of prescription eye drops to a covered person on and after January 1, 2022,
if:
(a) For a thirty-day supply:
(1) The amount of time has passed after which
a covered person should have used seventy percent (70%) of the dosage of the
prescription eye drops according to a healthcare professional's instructions on
the prescription; or
(2) Twenty-two
(22) days have passed from:
(A) The original
date the prescription eye drops were distributed to a covered person;
or
(B) The date the most recent
refill of the prescription eye drops was distributed to a covered
person;
(b)
The healthcare professional indicates on the original prescription that
additional quantities of the prescription eye drops are needed;
(c) A refill request of a covered person for
prescription eye drops does not exceed the number of additional quantities
needed as described in section (b) of this section; and
(d) The prescription eye drops prescribed by
a healthcare professional are a covered benefit under the health benefit plan
of the covered person.
SECTION
5.
ENFORCEMENT
Violations of this Rule shall constitute an unfair or deceptive
act under Ark. Code Ann. §
23-66-206.
Therefore, the penalties, actions or orders, including but not limited to
monetary fines, suspension, or revocation of license, as authorized under Ark.
Code Ann. §§
23-66-209
and
23-66-210,
shall apply to violations of this Rule.
SECTION 6.
EFFECTIVE DATE
The effective date of this Rule is January 1,2022.
