HB2124 HFLR Page 1 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 HOUSE OF REPRESENTATIVES - FLOOR VERSION STATE OF OKLAHOMA 1st Session of the 58th Legislature (2021) COMMITTEE SUBSTITUTE FOR HOUSE BILL NO. 2124 By: McEntire Townley, Frix, Grego and Moore of the House and McCortney, Stephens, Hicks and Taylor of the Senate 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: HB2124 HFLR Page 2 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Section 357. As used in this act: 1. "Commission" or "Pharmacy Choice Commission" means the Patient's Right to Pharmacy Choice Commission established by Section 6966 of Title 36 of the Okla homa Statutes; 2. "Covered entity" means a nonprofit hospital or medical service organization, insurer, health coverage plan or health 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 employed or reside in the state. This term does not include a health plan that provides coverage only for accidental injury, spec ified disease, hospital indemnity, disability income, or other limited benefit health insurance policies and contracts that do not include prescription drug coverage; 2. 3. "Covered individual" means a member, participant, enrollee, contract holder or pol icy holder or beneficiary of a covered entity who is provided health coverage by the covered entity. A covered individual includes any 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; HB2124 HFLR Page 3 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 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; 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 administrati on, 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 managemen t. The term includes a person or entity acting for a PBM in a HB2124 HFLR Page 4 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 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; 8. 9. "Plan sponsor" means the employers, insurance companies, unions and health maintenance organizations or any other entity responsible for establishing, maintaining, or administ ering 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, whi ch 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 p harmacy benefits management or any of the services included under the definition of pharmacy benefits management in this state, a pharmacy benefits manager or any entity acting as one in a contractual or employment relationship for a covered entity shall f irst obtain a license from the Pharmacy Choice Commission of the Oklahoma Insurance Department, and the Department Commission may charge a fee for such licensure. HB2124 HFLR Page 5 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 B. The Department Pharmacy Choice Commission shall establish, by regulation, licensure proce dures, 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 th at shall include the name and address of an agent for service of process, the payment of a requisite fee, and evidence of the procurement of a surety bond. C. The Department Pharmacy Choice Commission may subpoena witnesses and information. Its complianc e officers may take and copy records for investigative use and prosecutions. Nothing in this subsection shall limit the Office of the 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. HB2124 HFLR Page 6 BOLD FACE denotes Committee Amendments. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 SECTION 3. It being immediately necessary for the preservation of the public peace, health or safety, an emergency is hereby declared to exist, by reaso n whereof this act shall take effect and be in full force from and after its passage and approval. 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. COMMITTEE REPORT BY: COMMITTEE ON PUBLIC HEALTH, dated 02/24/2021 - DO PASS, As Amended and Coauthored.