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).