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STATE OF OKLAHOMA
1st Session of the 58th Legislature (2021)
COMMITTEE SUBSTITUTE
FOR
HOUSE BILL NO. 2124 By: McEntire
COMMITTEE SUBSTITUTE
An Act relating to professions and occupations;
amending Section 1, Chapter 263, O.S.L. 2014, as
amended by Section 7, Chapter 285, O.S.L. 2016 (59
O.S. Supp. 2020, Section 357), which relates to
definitions; defining term; amending Section 2,
Chapter 263, O.S.L. 2014 (59 O.S. Supp. 2020, Section
358), which relates to pharmacy benefits management
licensure; modifying the licensing entity; providing
for the levying of charges, fees, civil penalties or
restitution; declaring an emergency; and providing
for contingent effect.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY Section 1, Chapter 263, O.S.L.
2014, as amended by Section 7, Chapter 285, O.S.L. 2016 (59 O.S.
Supp. 2020, Section 357), is amended to read as follows:
Section 357. As used in this act:
1. "Commission" or "Pharmacy Cho ice Commission" means the
Patient's Right to Pharmacy Choice Commission established by Section
6966 of Title 36 of the Oklahoma Statutes;
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2. "Covered entity" means a nonprofit hospital or medical
service organization, insurer, health coverage plan or heal th
maintenance organization; a health program administered by the state
in the capacity of provider of health coverage; or an employer,
labor union, or other entity organized in the state that provides
health coverage to covered individuals who are employe d or reside in
the state. This term does not include a health plan that provides
coverage only for accidental injury, specified disease, hospital
indemnity, disability income, or other limited benefit health
insurance policies and contracts that do not in clude prescription
drug coverage;
2. 3. "Covered individual" means a member, participant,
enrollee, contract holder or policy holder or beneficiary of a
covered entity who is provided health coverage by the covered
entity. A covered individual includes a ny dependent or other person
provided health coverage through a policy, contract or plan for a
covered individual;
3. 4. "Department" means the Oklahoma Insurance Department;
4. 5. "Maximum allowable cost" or "MAC" means the list of drug
products delineating the maximum per -unit reimbursement for
multiple-source prescription drugs, medical product or device;
5. 6. "Multisource drug product reimbursement" (reimbursement)
means the total amount paid to a pharmacy inclusive of any reduction
in payment to the pharmacy, excluding prescription dispense fees;
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6. 7. "Pharmacy benefits management" means a service provided
to covered entities to facilitate the provision of prescription drug
benefits to covered individuals within the state, including
negotiating pricing and other terms with drug manufacturers and
providers. Pharmacy benefits management may include any or all of
the following services:
a. claims processing, retail network management and
payment of claims to pharmacies for prescription drugs
dispensed to covered individuals,
b. clinical formulary development and management
services,
c. rebate contracting and administration,
d. certain patient compliance, therapeutic intervention
and generic substitution programs, or
e. disease management programs;
7. 8. "Pharmacy benefits manager" or "PBM" means a person,
business or other entity that performs pharmacy benefits management.
The term includes a person or entity acting for a PBM in a
contractual or employment relationship in the performance of
pharmacy benefits management for a managed care company, nonprofit
hospital, medical service organization, insurance company, third -
party payor, or a health program administered by an agency of this
state;
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8. 9. "Plan sponsor" means the employers, insurance compan ies,
unions and health maintenance organizations or any other entity
responsible for establishing, maintaining, or administering a health
benefit plan on behalf of covered individuals; and
9. 10. "Provider" means a pharmacy licensed by the State Board
of Pharmacy, or an agent or representative of a pharmacy, including,
but not limited to, the pharmacy's contracting agent, which
dispenses prescription drugs or devices to covered individuals.
SECTION 2. AMENDATORY Section 2, Chapter 263, O.S.L.
2014 (59 O.S. Supp. 2020, Section 358), is amended to read as
follows:
Section 358. A. In order to provide pharmacy benefits
management or any of the services included under the definition of
pharmacy benefits management in this state, a pha rmacy benefits
manager or any entity acting as one in a contractual or employment
relationship for a covered entity shall first obtain a license from
the Pharmacy Choice Commission of the Oklahoma Insurance Department,
and the Department Commission may charge a fee for such licensure.
B. The Department Pharmacy Choice Commission shall establish,
by regulation, licensure procedures, required disclosures for
pharmacy benefits managers (PBMs) and other rules as may be
necessary for carrying out and enforcing the provisions of this act.
The licensure procedures shall, at a minimum, include the completion
of an application form that shall include the name and address of an
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agent for service of process, the payment of a requisite fee, and
evidence of the procure ment of a surety bond.
C. The Department Pharmacy Choice Commission may subpoena
witnesses and information. Its compliance officers may take and
copy records for investigative use and prosecutions. Nothing in
this subsection shall limit the Office of th e Attorney General from
using its investigative demand authority to investigate and
prosecute violations of the law.
D. The Department Pharmacy Choice Commission may suspend,
revoke or refuse to issue or renew a license for noncompliance with
any of the provisions hereby established or with the rules
promulgated by the Department Commission; for conduct likely to
mislead, deceive or defraud the public or the Department Commission;
for unfair or deceptive business practices or for nonpayment of a
renewal fee or fine. The Department Commission may also levy
administrative charges, fees, civil penalties, restitution or fines
for each count of which a licensee has been convicted in a
Department Commission hearing.
SECTION 3. It being immediate ly necessary for the preservation
of the public peace, health or safety, an emergency is hereby
declared to exist, by reason whereof this act shall take effect and
be in full force from and after its passage and approval.
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SECTION 4. The provisions of this act shall be contingent upon
the enactment of Enrolled House Bill No. 2123 of the 1st Session of
the 58th Oklahoma Legislature.
58-1-7754 AB 02/24/21