Arizona

Quick Facts

Key Provisions

• The foundational principle of Arizona's DPC law is that a direct primary care agreement does not constitute insurance. Under ARS § 20-123, DPC practices are explicitly exempt from the state's extensive insurance code (Title 20). This legal distinction is crucial, as it frees providers from the complex regulatory and financial reserve requirements imposed on insurance companies, allowing them to focus on the patient-physician relationship. For consumers, it clarifies that a DPC membership is a contract for medical services, not a health insurance policy, and should be paired with a separate plan for catastrophic coverage.
• Arizona law mandates that all DPC arrangements be formalized through a comprehensive written agreement, as outlined in ARS § 44-1799.92. This contract must be signed by both the provider (or their agent) and the patient (or their legal representative). The document must clearly specify the scope of primary care services included, the periodic fee amount, any potential fees for services not covered by the membership, the duration of the agreement, and the terms for automatic renewal. This requirement ensures complete transparency and prevents misunderstandings about the services and costs involved in the DPC relationship.
• To protect consumers, every DPC agreement must feature a prominent disclaimer stating in clear language that the agreement is not a health insurance policy. Furthermore, the law stipulates a fair termination process. Either the patient or the provider may terminate the agreement at any time by providing a 30-day written notice to the other party. This provision gives both sides a clear and predictable exit path, ensuring flexibility and preventing patients or providers from being locked into an arrangement that no longer serves their needs.
• A key provision designed to maintain the integrity of the DPC model is the prohibition on 'double-dipping.' The law explicitly forbids a DPC provider from submitting a claim for reimbursement to a patient's health insurance carrier for any primary care services that are already covered under the DPC agreement. This rule reinforces the separation between the direct-pay model and the insurance-based system, ensuring that insurers are not billed for services the patient has already paid for through their membership fee. It solidifies the DPC practice as a distinct and separate entity from the traditional fee-for-service insurance system.
• Arizona's DPC statutes include strong non-discrimination protections for patients under ARS § 44-1799.93. A provider is prohibited from declining to accept a new patient or discontinuing care for an existing patient solely because of that patient's health status. The law also mandates financial fairness, making it illegal for a provider to charge different membership fees for comparable services based on a patient's health status or gender. These protections ensure that DPC remains an accessible option for all individuals, regardless of their pre-existing conditions or demographic background.
• The law specifically defines which licensed professionals are permitted to offer DPC services. A 'primary care provider' can be a physician (MD or DO) specializing in family medicine, internal medicine, or pediatrics; a physician assistant (PA) who is practicing with a qualifying physician; or a registered nurse practitioner (NP) certified in family practice, adult health, gerontology, women's health, or pediatrics. This clear definition ensures that patients entering a DPC agreement are receiving care from appropriately qualified and licensed medical professionals within the scope of primary care.
• While the non-discrimination rules are robust, the law provides specific, reasonable exceptions for when a provider may decline or discontinue care. A practice is not required to accept new patients if it has reached its maximum patient capacity. Care can also be discontinued if a patient's condition evolves to require a level of care that the provider is unable to deliver. Other valid reasons for termination by the provider include a patient's failure to pay fees, engaging in fraud or misrepresentation, or exhibiting disruptive or abusive behavior that compromises the safety and function of the practice.

Medication Dispensing

In Arizona, physicians (MDs and DOs) operating a DPC practice are permitted to dispense medications directly to their own patients, but they must adhere to the state's general physician dispensing laws under ARS Title 32. This is not a DPC-specific exemption but rather a utilization of existing statutes. To do so, the physician must register with the Arizona Medical Board and pay the required fee. All drugs and devices must be stored in a locked cabinet or a secure, controlled-access room, with an ongoing inventory and written access procedures. Dispensing can only occur under the direct supervision of the physician, who must be present to determine the legitimacy and advisability of the prescription for a condition they are actively treating.

Medicaid Provisions

Arizona's Direct Primary Care statutes do not contain any specific provisions, guidelines, or prohibitions related to the state's Medicaid program (the Arizona Health Care Cost Containment System, or AHCCCS) or state employee health plans. The law is silent on whether Medicaid can be used to pay for DPC membership fees or how DPC services should be coordinated with Medicaid coverage. This lack of state-level guidance means that any potential integration is governed by federal Medicaid regulations and the specific policies of AHCCCS, leaving it an area without explicit legal clarity within the state's DPC framework.