Arizona became the Fifth state to pass DPC related legislation, enacted in 2014 with Senate Bill 1404. For the text of the law, see Arizona Revised Statutes § 20-123. This original effort failed to provide a clear definition of DPC, failed to provide a clear path for protection from the insurance commissioner (note the emphasized phrase below "if the plan does not assume financial risk" - which leaves the debate open and makes the law meaningless) and had no consumer protections of any kind, increasing the chance that it would fail to survive judicial scrutiny. Fortunately Arizona modified its existing (previously irrelevant) DPC law by passing companion bills in the House (HB 2113) and Senate (SB 1105)which was signed by the governor on 04/17/19. This language is included below in its entirety.
“Be it enacted by the Legislature of the State of Arizona:
Section 1. Section 20-103, Arizona Revised Statutes, is amended to read:
20-103. Definition of insurance; exceptions E. Direct primary care AGREEMENTS AS DEFINED IN SECTION 44‑1799.91 are not insurance, and this title does not apply to those agreements.”
ARTICLE 25. DIRECT PRIMARY CARE AGREEMENTS 44-1799.91. Definitions
IN THIS ARTICLE, UNLESS THE CONTEXT OTHERWISE REQUIRES:
1. "DIRECT PRIMARY CARE AGREEMENT" MEANS A CONTRACT BETWEEN A PRIMARY CARE PROVIDER AND AN INDIVIDUAL PATIENT OR THE PATIENT'S LEGAL REPRESENTATIVE IN WHICH THE PRIMARY CARE PROVIDER AGREES TO PROVIDE PRIMARY CARE SERVICES TO THE INDIVIDUAL PATIENT FOR AN AGREED PERIODIC FEE AND PERIOD OF TIME.
2. "DIRECT PRIMARY CARE PATIENT" MEANS A PATIENT WHO ENTERS INTO A DIRECT PRIMARY CARE AGREEMENT WITH A PRIMARY CARE PROVIDER.
3. "DIRECT PRIMARY CARE PROVIDER" MEANS A PRIMARY CARE PROVIDER WHO ENTERS INTO A DIRECT PRIMARY CARE AGREEMENT WITH A PATIENT OR THE PATIENT'S LEGAL REPRESENTATIVE.
4. "PRIMARY CARE PROVIDER":
(i) A PHYSICIAN WHO IS LICENSED PURSUANT TO TITLE 32, CHAPTER 13 OR 17 AND WHO SPECIALIZES IN FAMILY MEDICINE, INTERNAL MEDICINE OR PEDIATRICS OR OTHERWISE TREATS PATIENTS FOR CHRONIC CONDITIONS REQUIRING REGULAR TREATMENT.
(ii) A PHYSICIAN ASSISTANT WHO IS LICENSED PURSUANT TO TITLE 32, CHAPTER 25 AND WHO PRACTICES WITH A PHYSICIAN WHO SPECIALIZES IN FAMILY MEDICINE, INTERNAL MEDICINE OR PEDIATRICS.
(iii) A REGISTERED NURSE PRACTITIONER WHO IS LICENSED PURSUANT TO TITLE 32, CHAPTER 15 AND WHO IS CERTIFIED IN FAMILY PRACTICE, ADULT HEALTH, GERONTOLOGY, WOMEN'S HEALTH OR PEDIATRICS.
(iv) A DENTIST WHO IS LICENSED PURSUANT TO TITLE 32, CHAPTER 11 AND WHO PROVIDES DENTAL SERVICES.
(b) INCLUDES A GROUP, ENTITY OR PRACTICE OF PRIMARY CARE PROVIDERS.
5. "PRIMARY CARE SERVICES" MEANS ROUTINE, PERIODIC HEALTH CARE PROCEDURES THAT ARE ORDERED AND SUPERVISED BY A PRIMARY CARE PROVIDER, INCLUDING MEDICAL VISITS, LABORATORY TESTING, IMAGING, PATHOLOGY TESTING, PRESCRIBING AND ADMINISTERING MEDICATION, DIAGNOSING, TREATING AND MANAGING ACUTE AND CHRONIC CONDITIONS AND OTHER HEALTH CARE PROCEDURES PROVIDED TO PATIENTS ON A ROUTINE, PERIODIC BASIS THAT MAY BE PERFORMED OR SUPERVISED BY A PRIMARY CARE PROVIDER WITH TRAINING AND EXPERIENCE IN THAT PROCEDURE, OR DENTAL SERVICES THAT MAY BE PERFORMED OR SUPERVISED BY A DENTIST WHO IS LICENSED PURSUANT TO TITLE 32, CHAPTER 11.
44-1799.92. Direct primary care agreements; requirements; notice
A DIRECT PRIMARY CARE AGREEMENT SHALL MEET ALL OF THE FOLLOWING REQUIREMENTS:
1. BE IN WRITING.
2. BE SIGNED BY THE PRIMARY CARE PROVIDER OR AN AGENT OF THE PRIMARY CARE PROVIDER AND THE INDIVIDUAL PATIENT OR THE PATIENT'S LEGAL REPRESENTATIVE. A COPY OF THE AGREEMENT SHALL BE PROVIDED TO THE INDIVIDUAL PATIENT OR THE PATIENT'S LEGAL REPRESENTATIVE.
3. ALLOW EITHER PARTY TO TERMINATE THE AGREEMENT ON A THIRTY-DAY WRITTEN NOTICE TO THE OTHER PARTY. THE AGREEMENT SHALL INCLUDE TERMS FOR RELOCATION AND MILITARY DUTY.
4. DESCRIBE THE SCOPE OF PRIMARY CARE SERVICES THAT ARE COVERED BY THE PERIODIC FEE.
5. SPECIFY THE PERIODIC FEE FOR THE AGREEMENT AND ANY ADDITIONAL FEES OUTSIDE OF THE PERIODIC FEE FOR ONGOING CARE UNDER THE AGREEMENT.
6. SPECIFY THE DURATION OF THE AGREEMENT AND ANY AUTOMATIC RENEWAL PERIODS.
7. PROVIDE A PROMINENT WRITTEN DISCLAIMER THAT THE AGREEMENT IS NOT HEALTH INSURANCE AND THAT READS, IN SUBSTANTIALLY THE FOLLOWING FORM:
NOTICE: THE ORGANIZATION FACILITATING THE DIRECT PRIMARY CARE AGREEMENT IS NOT AN INSURANCE COMPANY AND THE DIRECT PRIMARY CARE COMPANY GUIDELINES AND AGREEMENT ARE NOT AN INSURANCE POLICY. PARTICIPATION IN THE DIRECT PRIMARY CARE AGREEMENT OR A SUBSCRIPTION TO ANY OF ITS DOCUMENTS SHOULD NOT BE CONSIDERED TO BE A HEALTH INSURANCE POLICY. REGARDLESS OF WHETHER YOU RECEIVE TREATMENT FOR HEALTH CARE ISSUES THROUGH THE DIRECT PRIMARY CARE AGREEMENT, YOU ARE ALWAYS PERSONALLY RESPONSIBLE FOR PAYING ANY ADDITIONAL HEALTH CARE EXPENSES YOU MAY INCUR. IF YOU HAVE HEALTH INSURANCE, IT MAY INCLUDE, AT NO ADDITIONAL CHARGE, SOME OF THE PREVENTIVE SERVICES THAT ARE ALSO AVAILABLE UNDER THIS DIRECT PRIMARY CARE AGREEMENT. THE PRIMARY CARE PROVIDER MAY NOT BILL YOUR HEALTH INSURANCE FOR PRIMARY CARE SERVICES PROVIDED UNDER THIS DIRECT PRIMARY CARE AGREEMENT.
44-1799.93. Direct primary care provider; acceptance and discontinuance of patients
A. A DIRECT PRIMARY CARE PROVIDER MAY NOT DECLINE TO ACCEPT A NEW DIRECT PRIMARY CARE PATIENT OR DISCONTINUE CARE TO AN EXISTING PATIENT SOLELY BECAUSE OF THE PATIENT'S HEALTH STATUS. A DIRECT PRIMARY CARE PROVIDER MAY NOT CHARGE DIFFERENT FEES FOR COMPARABLE SERVICES BASED ON A PATIENT'S HEALTH STATUS OR GENDER.
B. A DIRECT PRIMARY CARE PROVIDER MAY DECLINE TO ACCEPT A PATIENT IF THE PROVIDER HAS REACHED MAXIMUM CAPACITY OR IF THE PATIENT'S MEDICAL CONDITION IS SUCH THAT THE PROVIDER IS UNABLE TO PROVIDE THE APPROPRIATE LEVEL AND TYPE OF PRIMARY CARE SERVICES THE PATIENT REQUIRES.
C. A DIRECT PRIMARY CARE PROVIDER MAY DISCONTINUE CARE FOR A DIRECT PRIMARY CARE PATIENT IN ANY OF THE FOLLOWING CIRCUMSTANCES:
1. THE PATIENT FAILS TO PAY THE PERIODIC FEE.
2. THE PATIENT HAS PERFORMED AN ACT OF FRAUD.
3. THE PATIENT REPEATEDLY FAILS TO ADHERE TO THE RECOMMENDED TREATMENT PLAN.
4. THE PATIENT IS ABUSIVE AND PRESENTS AN EMOTIONAL OR PHYSICAL DANGER TO THE STAFF OR OTHER PATIENTS OF THE DIRECT PRIMARY CARE PROVIDER.
5. THE DIRECT PRIMARY CARE PROVIDER DISCONTINUES PRACTICING AS A DIRECT PRIMARY CARE PROVIDER.
6. THE DIRECT PRIMARY CARE PROVIDER CHANGES THE SERVICES OFFERED OR THE SCOPE OF PRACTICE PROVIDED TO PATIENTS.
7. THE DIRECT PRIMARY CARE PROVIDER GIVES A THIRTY‑DAY WRITTEN NOTICE TO THE PATIENT TERMINATING THE DIRECT PRIMARY CARE AGREEMENT.
44-1799.94. Direct primary care agreements; fees
A. A DIRECT PRIMARY CARE AGREEMENT MAY NOT REQUIRE MORE THAN TWELVE MONTHS OF THE PERIODIC FEE TO BE PAID IN ADVANCE. ON DISCONTINUING THE AGREEMENT ALL PAYMENTS PREPAID FOR MONTHS FOLLOWING TERMINATION OF THE AGREEMENT SHALL BE RETURNED TO THE PATIENT.
B. A DIRECT PRIMARY CARE AGREEMENT SHALL PROHIBIT THE DIRECT PRIMARY CARE PROVIDER FROM SUBMITTING A CLAIM FOR REIMBURSEMENT TO THE PATIENT'S HEALTH CARE INSURER FOR PRIMARY CARE SERVICES THAT ARE PROVIDED TO THE PATIENT AND THAT ARE COVERED UNDER THE DIRECT PRIMARY CARE AGREEMENT.
C. A DIRECT PRIMARY CARE AGREEMENT MAY ALLOW THE PERIODIC FEE AND ANY ADDITIONAL FEES FOR ONGOING CARE UNDER THE AGREEMENT TO BE PAID BY A HEALTH CARE INSURER OR OTHER THIRD PARTY.
44-1799.95. Direct primary care agreements; dentists
A DIRECT PRIMARY CARE AGREEMENT FOR DENTAL SERVICES IS LIMITED TO SERVICES PROVIDED WITHIN A SINGLE PROFESSIONAL PRACTICE AND MAY NOT INCLUDE SERVICES OFFERED BY DENTISTS IN OTHER PRACTICE ENTITIES.
44-1799.96. Direct primary care agreements; regulation
A DIRECT PRIMARY CARE AGREEMENT FOR MEDICAL OR DENTAL SERVICES DOES NOT CONSTITUTE THE TRANSACTION OF INSURANCE BUSINESS OR A HEALTH CARE SERVICES ORGANIZATION IN THIS STATE FOR THE PURPOSES OF REGULATION UNDER TITLE 20.
Even though clean DPC defining “not insurance” legislation is now on the books (listed above), physicians might still want to review Title 20 (Insurance) of the Arizona Revised Statutes. Please note Section 20-103
Prescription Medication Dispensing is permitted in Arizona. Physicians do need to register with their appropriate board of medicine. DOs may use this form and MDs may use this form. This DO FAQ form might also be a useful reference.
A. Except as provided in subsection B of this section, a doctor of medicine may dispense drugs and devices kept by the doctor if:
1. All drugs are dispensed in packages labeled with the following information:
(a) The dispensing doctor's name, address and telephone number.
(b) The date the drug is dispensed.
(c) The patient's name.
(d) The name and strength of the drug, directions for its use and any cautionary statements.
2. The dispensing doctor enters into the patient's medical record the name and strength of the drug dispensed, the date the drug is dispensed and the therapeutic reason.
3. The dispensing doctor keeps all drugs in a locked cabinet or room, controls access to the cabinet or room by a written procedure and maintains an ongoing inventory of its contents.
4. The doctor registers with the board to dispense drugs and devices and pays the registration fee prescribed by section 32-1436.
B. A doctor of medicine may not dispense a schedule II controlled substance that is an opioid, except for an implantable device or an opioid that is for medication-assisted treatment for substance use disorders.
C. Except in an emergency situation, a doctor who dispenses drugs without being registered by the board to do so is subject to a civil penalty by the board of not less than three hundred dollars and not more than one thousand dollars for each transaction and is prohibited from further dispensing for a period of time as prescribed by the board.
D. Before a physician dispenses a drug pursuant to this section, the physician shall give the patient a prescription and inform the patient that the prescription may be filled by the prescribing physician or by a pharmacy of the patient's choice.
E. A doctor shall dispense only to the doctor's own patient and only for conditions being treated by that doctor. The doctor shall provide direct supervision of a medical assistant, nurse or attendant involved in the dispensing process. For the purposes of this subsection, "direct supervision" means that a doctor is present and makes the determination as to the legitimacy or the advisability of the drugs or devices to be dispensed.
F. This section shall be enforced by the board, which shall establish rules regarding labeling, recordkeeping, storage and packaging of drugs that are consistent with the requirements of chapter 18 of this title. The board may conduct periodic reviews of dispensing practices to ensure compliance with this section and applicable rules.
G. For the purposes of this section, "dispense" means the delivery by a doctor of medicine of a prescription drug or device to a patient, except for samples packaged for individual use by licensed manufacturers or repackagers of drugs, and includes the prescribing, administering, packaging, labeling and security necessary to prepare and safeguard the drug or device for delivery.
Here is the old AZ DPC law analysis (now replaced by the language above).