{"text_format":"1","workbook":"xlsx","n_sheets":13,"sheets":["Overview","User Control","Validation Errors","IAD","NID","SAR","IPD","PLN","PCT","PDT","PDD","ReferenceData-ARCounties","Validation"],"not_rendered":{"charts":0,"images":0,"macros":1,"external_links":0,"defined_names":11,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"Overview","index":0,"n_rows":22,"n_cols":3,"rows_kept":22,"cut":false,"hidden":false,"merged":[[18,2,18,14],[20,2,20,14],[21,2,21,14],[14,2,14,14],[16,2,16,14],[17,2,17,14],[10,2,10,14],[11,2,11,14],[12,2,12,14],[13,2,13,14],[15,2,15,14],[9,2,9,14],[2,2,2,14],[3,2,3,14],[5,2,5,14],[6,2,6,14],[8,2,8,14]]}
[]
[]
[null,null,"2026 PBM Data Submissions"]
[null,null,"Updated 2/18/2026"]
[]
[null,null,"1. Overview and Purpose"]
[null,null,"Insurers covered under Rule 118 & Arkansas Code § 23-92-509(b)(2)(B) which use a PBM in Arkansas within its networks must submit this completed template to the Arkansas Insurance Department (AID). Data must be submitted annually for each network using the PBM. Completed templates must be submitted by March 1st."]
[]
[null,null,"2. Tab Descriptions"]
[null,null,"This template has a total of 8 tabs. Please review the descriptions of each worksheet below."]
[null,null,"User Control: This tab provides the Issuer with step-by-step instructions on how to successfully complete this template. Please review your issuer information, review the notes and instructions table and then begin following the step-by-step Actions."]
[null,null,"IAD (Issuer Administrative Data): Name, address, NAIC, TIN, CEO, CFO, contact for communicating data submission problems, and PBM details."]
[null,null,"NID (Network ID): Networks associated with one or more plans."]
[null,null,"SAR (Service Areas): Service Areas associated with one or more plans."]
[null,null,"IPD (Issuer Plan Data): The \"plan\" information requested here is how CMS interprets a plan to be. It is not the insurer that many in the industry refer to as a \"plan.\" A plan can have only one pharmacy network associated with it."]
[null,null,"PLN (Pharmacy Locations): Only retail community pharmacies for which the NUCC Taxonomy 3336C0003X applies are to be reported. For details, refer to the document “Applicable Community Retail Pharmacy Taxonomic Definition” in the webpage   https://rhld.insurance.arkansas.gov/PBMRegulation. Inclusion of pharmacies not catering to the general public or pharmacies that specialize only in certain drugs is strictly prohibited, as it leads to an incorrect evaluation of adequacy."]
[null,null,"PCT (Pharmacy Contract Terminations): To be completed only if there were contract termination(s) due to compensation issues in the prior calendar year. If there were none, leave blank, and check the \"Issuer has no PCT data to report\" checkbox on User Control."]
[null,null,"PDT (Pharmacy Declinations Totals): To be completed only if there were drug declination(s) due to compensation issues in the prior calendar year. If there were none, leave blank, and check the \"Issuer has no PDT data to report\" checkbox on User Control."]
[null,null,"PDD (Pharmacy Declinations Details): To be completed only per request by the Arkansas Insurance Department (AID)."]
[]
[null,null,"3. Conclusion"]
[null,null,"Please proceed to the User Control tab to begin. If you need any clarifications on the use of this template, please contact your Compliance Officer or email RHLD.DataOversight@arkansas.gov."]

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[]
[null,null,"2026 PBM Data Submissions"]
[null,null,"User Instructions & Details"]
[]
[null,null,"Issuer Information"]
[null,null,"NAIC Number:"]
[null,null,"Date:"]
[]
[null,null,null,null,null,"Not Validated",null,false]
[]
[null,null,null,null,null,null,null,false]
[null,null,"Notes & Instructions"]
[]
[]
[null,null,"Click here for complete usage instructions"]
[null,null,"(see Reporting Data Specifications at top of linked page)"]

{"sheet":"Validation Errors","index":2,"n_rows":2,"n_cols":3,"rows_kept":2,"cut":false,"hidden":false,"merged":[[0,0,0,2]]}
["Below are the validation errors that were identified. Please correct them and revalidate."]
["Sheet","Cell","Message"]

{"sheet":"IAD","index":3,"n_rows":39,"n_cols":5,"rows_kept":39,"cut":false,"hidden":false,"merged":[[0,0,0,2],[1,0,1,2]]}
["Arkansas Rule 118 Administrative Data Template v1.0"]
["(Adapted from CMS/CCIIO Administrative Template) "]
[]
["1. Administrative Name Data "]
["Company Legal Name:*","Issuer Legal Name:*","Issuer Marketing Name:*"]
[]
[]
["2. TIN/NAIC"]
["TIN:*","NAIC Company Code*:","NAIC Group Code (if any):"]
[]
[]
["3. Company Address "]
["Address:*","Address 2 (optional): ","City:*","State:*","Zip Code:*"]
[]
[]
["4. Issuer Address"]
["Address:*","Address 2 (optional): ","City:*","State:*","Zip Code:*"]
[]
[]
["5. CEO"]
["First Name:* ","Last Name:* ","E-mail Address:* ","Phone Number:* ","Phone Extension: "]
[]
[]
["6. CFO "]
["First Name:* ","Last Name:* ","E-mail Address:* ","Phone Number:* ","Phone Extension: "]
[]
[]
["7. Contact(s) for communicating data submission problems (only one is required)"]
["First Name:* ","Last Name:* ","E-mail Address:* ","Phone Number:* ","Phone Extension: "]
[]
[]
[]
["8. PBM details "]
["Number (if more than one PBM)","Legal Name of PBM*","TIN*","PBM Contact Name*","Phone Number with Extension*"]
[1]
[2]
[3]
[4]
[5]

{"sheet":"NID","index":4,"n_rows":3,"n_cols":3,"rows_kept":3,"cut":false,"hidden":false,"merged":[[0,0,0,2]]}
["Network ID (NID)"]
["Network ID*","Network Name*","Network URL*"]
["Required:\nProvide Network ID","Required:\nEnter the Network Name","Required:\nEnter the Network URL"]

{"sheet":"SAR","index":5,"n_rows":3,"n_cols":4,"rows_kept":3,"cut":false,"hidden":false,"merged":[[0,0,0,3]]}
["Service Areas (SAR)"]
["Service Area ID*","Service Area Name*","Entire State Flag*","County FIPS Code"]
["Required:\nEnter the Service Area ID","Required:\nEnter the Service Area Name","Required:\nDoes this Service Area cover the entire state?","Required if State is \"No\":\nSelect the County - FIPS this Service Area covers"]

{"sheet":"IPD","index":6,"n_rows":3,"n_cols":7,"rows_kept":3,"cut":false,"hidden":false,"merged":[[0,0,0,6]]}
["Issuer Plan Data (IPD)"]
["Plan ID*","Plan Marketing Name*","Network ID*","Service Area ID*","Plan Introduction Date*","Plan Termination Date","Plan Market Type*"]
["Required: \r\nPlan id. See 'Reporting Data Specification' document for explanation","Required:\nProvide the marketing name of the Plan","Required:\nEnter the Network ID associated with the plan ID","Required:\nEnter the Service area associated with the Plan ID","Required: Date plan was made (or will be made) available to consumers","Date last enrollee terminated after plan withdrawal from market by issuer","Required: Whether “Individual”, “Small Group”,“Large Group”,\"PASSE\" or \"Other\""]

{"sheet":"PLN","index":7,"n_rows":2,"n_cols":9,"rows_kept":2,"cut":false,"hidden":false,"merged":[[0,0,0,8]]}
["Retail Pharmacy Locations (PLN)"]
["National Provider Identifier (NPI)*","Facility Name*","Street Address*","Street Address 2","City*","State*","County* (5 Digit FIPS Code)","Zip*","Network IDs*"]

{"sheet":"PCT","index":8,"n_rows":2,"n_cols":10,"rows_kept":2,"cut":false,"hidden":false,"merged":[[0,0,0,9]]}
["Pharmacy Contract Terminations (PCT)"]
["National Provider Identifier (NPI)*","Facility Name*","Street Address*","Street Address 2","City*","State*","County* (5 Digit FIPS Code)","Zip*","Network IDs*","Termination Date*"]

{"sheet":"PDT","index":9,"n_rows":2,"n_cols":10,"rows_kept":2,"cut":false,"hidden":false,"merged":[[0,0,0,9]]}
["Pharmacy Declination Totals (PDT)"]
["National Provider Identifier (NPI)*","Facility Name*","Street Address*","Street Address 2","City*","State*","County* (5 Digit FIPS Code)","Zip*","Network IDs*","Total Declinations Count"]

{"sheet":"PDD","index":10,"n_rows":2,"n_cols":14,"rows_kept":2,"cut":false,"hidden":false,"merged":[[0,0,0,13]]}
["Pharmacy Declination Details (PDD)"]
["National Provider Identifier (NPI)*","Facility Name*","Street Address*","Street Address 2","City*","State*","County* (5 Digit FIPS Code)","Zip*","Network ID*","Issuer Plan ID*","PBM TIN*","Timestamp Denied*","Drug Denied NDC*","Drug Denied RXCUI (optional)"]

{"sheet":"ReferenceData-ARCounties","index":11,"n_rows":76,"n_cols":2,"rows_kept":76,"cut":false,"hidden":false,"merged":[]}
["CountyFIPS","CountyName"]
[5001,"Arkansas                 "]
[5003,"Ashley                   "]
[5005,"Baxter                   "]
[5007,"Benton                   "]
[5009,"Boone                    "]
[5011,"Bradley                  "]
[5013,"Calhoun                  "]
[5015,"Carroll                  "]
[5017,"Chicot                   "]
[5019,"Clark                    "]
[5021,"Clay                     "]
[5023,"Cleburne                 "]
[5025,"Cleveland                "]
[5027,"Columbia                 "]
[5029,"Conway                   "]
[5031,"Craighead                "]
[5033,"Crawford                 "]
[5035,"Crittenden               "]
[5037,"Cross                    "]
[5039,"Dallas                   "]
[5041,"Desha                    "]
[5043,"Drew                     "]
[5045,"Faulkner                 "]
[5047,"Franklin                 "]
[5049,"Fulton                   "]
[5051,"Garland                  "]
[5053,"Grant                    "]
[5055,"Greene                   "]
[5057,"Hempstead                "]
[5059,"Hot Spring               "]
[5061,"Howard                   "]
[5063,"Independence             "]
[5065,"Izard                    "]
[5067,"Jackson                  "]
[5069,"Jefferson                "]
[5071,"Johnson                  "]
[5073,"Lafayette                "]
[5075,"Lawrence                 "]
[5077,"Lee                      "]
[5079,"Lincoln                  "]
[5081,"Little River             "]
[5083,"Logan                    "]
[5085,"Lonoke                   "]
[5087,"Madison                  "]
[5089,"Marion                   "]
[5091,"Miller                   "]
[5093,"Mississippi              "]
[5095,"Monroe                   "]
[5097,"Montgomery               "]
[5099,"Nevada                   "]
[5101,"Newton                   "]
[5103,"Ouachita                 "]
[5105,"Perry                    "]
[5107,"Phillips                 "]
[5109,"Pike                     "]
[5111,"Poinsett                 "]
[5113,"Polk                     "]
[5115,"Pope                     "]
[5117,"Prairie                  "]
[5119,"Pulaski                  "]
[5121,"Randolph                 "]
[5123,"St. Francis              "]
[5125,"Saline                   "]
[5127,"Scott                    "]
[5129,"Searcy                   "]
[5131,"Sebastian                "]
[5133,"Sevier                   "]
[5135,"Sharp                    "]
[5137,"Stone                    "]
[5139,"Union                    "]
[5141,"Van Buren                "]
[5143,"Washington               "]
[5145,"White                    "]
[5147,"Woodruff                 "]
[5149,"Yell                     "]

{"sheet":"Validation","index":12,"n_rows":0,"n_cols":0,"rows_kept":0,"cut":false,"hidden":true,"merged":[]}