On February 24, the Arkansas Department of Insurance set out revised procedures for “gold card” appeals to comply with Act 511 of 2025, and issuing Bulletin No. 4-2026 in place of now-repealed Bulletin 16-2024.
Arkansas’s “gold card” program allows certain healthcare providers to qualify for an exemption from a healthcare insurer’s prior authorization requirements. In some contexts, it also gives providers exemptions from a Pharmacy Benefit Manager’s (PBM) requirement. Providers generally qualify based on meeting a high prior-authorization approval threshold for a particular healthcare service, and the exemption is tied to a defined evaluation period and notice process set out in the Arkansas Code.
In the recent bulletin, the Department of Insurance described two Arkansas-specific independent review pathways; one to appeal the rescission of a healthcare insurer gold card, another to appeal a PBM rescission, following a healthcare or medication request.
For Arkansas healthcare insurers, the Arkansas Insurance Department bulletin states that a provider may appeal a rescission to an independent review organization (IRO) within 12 months of receiving proper notice, filed per the insurer’s instructions. They may also request review of a second random sample of claims, if certain claims-eligibility conditions are met.
Upon receipt of an appeal request, the insurer must immediately conduct a preliminary review for completeness and eligibility and must notify the Insurance Commissioner (at the bulletin’s designated email) and the provider in writing whether the appeal is complete and eligible. If incomplete, the insurer must issue a deficiency notice within two business days, the provider has one business day to cure, and the insurer has one business day to re-review.
The bulletin further assigns the Arkansas Insurance Commissioner a role in selecting an IRO within two business days after notice that an appeal is complete and eligible, and it sets insurer production deadlines to the IRO, including two business days to provide specified records and materials after the IRO assignment and additional timing requirements if a second random sample is requested. The IRO must complete review within 30 days of the provider’s filing, or 60 days if a second random sample is requested, and must notify the provider, insurer, and the Arkansas Insurance Commissioner.
Separately, for prescription drug exemption denials, the Arkansas Insurance Department bulletin provides that an insurer or PBM may appeal to the State Insurance Department within 90 days of the denial, must give the Arkansas State Board of Pharmacy and the Arkansas State Medical Board seven days’ notice of intent to appeal, must file by emailing the Insurance Commissioner with specified attachments, and the Arkansas Insurance Commissioner must appoint an IRO no later than the 30th day after the appeal is filed. Then, the IRO must issue written notice of its decision within 45 days after receiving the appeal to the appellant, both boards, and the Insurance Commissioner.
