Oklahoma 2022 Regular Session

Oklahoma House Bill HB2677 Compare Versions

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Version 2 (New)

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1		-	An Act
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4		-	ENROLLED HOUSE
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	28	+	ENGROSSED SENATE AMENDMENTS
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5	31		BILL NO. 2677 By: Marti, Caldwell (Trey),
6	32		Fugate, West (Tammy),
7	33		Dollens, Davis and Sneed of
8	34		the House
9	35
10	36		and
11	37
12		-	McCortney~~, Bergstrom and~~
13		-	~~Garvin of the Senate~~
	38	+	McCortney of the Senate
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18	44		An Act relating to professions and occupations ;
19	45		amending 59 O.S. 2011, Section 356.2, which relates
20	46		to the Pharmacy Audit Integrity Act ; modifying and
21	47		expanding duties; prohibiting certain audits;
22	48		providing for discrepancies; requiring acceptance of
23	49		certain evidence; requiring provision of certain
24	50		documents within specifi ed time; providing audit
25	51		requirements; modifying number of prescriptions to be
26	52		audited; requiring invoices; modifying audit report
27	53		time periods; eliminating certain withholdings;
28	54		amending 59 O.S. 2011, Section 356.3, which relates
29	55		to appeals process; clari fying when certain findings
30	56		are to be referred to the district attorney;
31		-	clarifying scope of application; amending Section 2,
	57	+	clarifying scope of application; amending Section 3,
32	58		Chapter 263, O.S.L. 2014 (59 O.S. Supp. 2020 , Section
33		-	358), which relates to pharmacy benefits management ;
34		-	modifying reference; amending Section 3, Chapter 263,
35		-	O.S.L. 2014 (59 O.S. Supp. 2020 , Section 359), which
36		-	relates to information to be provided by pharmacy
37		-	benefits manager; removing exceptions; amending
38		-	Section 4, Chapter 263, O.S.L. 2014, as amended by
39		-	Section 8, Chapter 285, O.S.L. 2016 (59 O.S. Supp.
40		-	2020, Section 360), which relates to contractual
41		-	duties to providers; modifying reimbursement
42		-	procedure; prohibiting placement of drugs on certain
43		-	list, with exceptions; modifying accreditation or
44		-	licensing requirement; allowing certain entities to
45		-	decline to provide services; requiring prov ision of
46		-	certain information; and declaring an emergency .
	59	+	359), which relates to information to be provided by
	60	+	pharmacy benefits manag er; removing exceptions;
	61	+	amending Section 4, Chapter 263, O.S.L. 2014, as
	62	+	amended by Section 8, Chapter 285, O.S.L. 2016 (59
	63	+	O.S. Supp. 2020, Section 360), which relates to
	64	+	contractual duties to providers; modifying
	65	+	reimbursement procedure; prohibiting pla cement of
	66	+	drugs on certain list, with exceptions; modifying
	67	+	accreditation or licensing requirement; allowing
	68	+	certain entities to decline to provide services;
	69	+	requiring provision of certain information; and
	70	+	declaring an emergency .
47	71
48		-	ENR. H. B. NO. 2677 Page 2
49		-	SUBJECT: Professions and occupations
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	101	+	AUTHOR: Add the following Senate Coauthors: Bergstrom and Garvin
	102	+
	103	+	AMENDMENT NO. 1. Page 8, line 22, delete after the number “5” and
	104	+	before the word “not”, the word “May”
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	106	+
	107	+	AMENDMENT NO. 2. Page 11, line 1 1/2, insert a new Section 3 to
	108	+	read
	109	+
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	111	+	“SECTION 3. AMENDATORY Sec tion 2, Chapter 263, O.S.L.
	112	+	2014 (59 O.S. Supp. 2020, Section 358), is amended to read as
	113	+	follows:
	114	+
	115	+	Section 358. A. In order to provide pharmacy benefits
	116	+	management or any of the services included under the definition of
	117	+	pharmacy benefits management in t his state, a pharmacy benefits
	118	+	manager or any entity acting as one in a contractual or employment
	119	+	relationship for a covered entity shall first obtain a license from
	120	+	the Oklahoma Insurance Department, and the Department may charge a
	121	+	fee for such licensure.
	122	+	B. The Department shall establish, by regulation, licensure
	123	+	procedures, required disclosures for pharmacy benefits managers
	124	+	(PBMs) and other rules as may be necessary for carrying out and
	125	+	enforcing the provisions of this act. The licensure procedures
	126	+	shall, at a minimum, include the completion of an application form
	127	+	that shall include the name and address of an agent for service of
	128	+	process, the payment of a requisite fee, and evidence of the
	129	+	procurement of a surety bond.
	130	+	C. The Department may subpoena w itnesses and information. Its
	131	+	compliance officers may take and copy records for investigative use
	132	+	and prosecutions. Nothing in this subsection shall limit the Office
	133	+	of the Attorney General from using its investigative demand
	134	+	authority to investigate and prosecute violations of the law.
	135	+	D. The Department may suspend, revoke or refuse to issue or
	136	+	renew a license for noncompliance with any of the provisions hereby
	137	+	established or with the rules promulgated by the Department; for
	138	+	conduct likely to mislead, d eceive or defraud the public or the
	139	+	Department; for unfair or deceptive business practices or for
	140	+	nonpayment of a renewal fee or fine. The Department may also levy
	141	+	administrative fines for each count of which a licensee PBM has been
	142	+	convicted in a Departm ent hearing.”
	143	+
	144	+	and renumber subsequent sections
	145	+
	146	+	and amend the title to conform
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	173	+	Passed the Senate the 22nd day of April, 2021.
	174	+
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	176	+
	177	+	Presiding Officer of the Senate
	178	+
	179	+
	180	+	Passed the House of Representatives the ____ day of __________,
	181	+	2021.
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	185	+	Presiding Officer of the House
	186	+	of Representatives
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	213	+	ENGROSSED HOUSE
	214	+	BILL NO. 2677 By: Marti, Caldwell (Trey),
	215	+	Fugate, West (Tammy),
	216	+	Dollens, Davis and Sneed of
	217	+	the House
	218	+
	219	+	and
	220	+
	221	+	McCortney of the Senate
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	227	+	An Act relating to professions and occupations ;
	228	+	amending 59 O.S. 2011, Section 356.2, which relates
	229	+	to the Pharmacy Audit Integrity Act ; modifying and
	230	+	expanding duties; prohibiting certain audits;
	231	+	providing for discrepancies; requiring acceptance of
	232	+	certain evidence; requiring provision of certain
	233	+	documents within specified time; providing audit
	234	+	requirements; modifying number of prescriptions to be
	235	+	audited; requiring invoices; modifying audit report
	236	+	time periods; eliminating certain withholdings;
	237	+	amending 59 O.S. 2011, Section 356.3, which relates
	238	+	to appeals process; clarifying when certain findings
	239	+	are to be referred to the district attorney;
	240	+	clarifying scope of application; amending Section 3,
	241	+	Chapter 263, O.S.L. 2014 (59 O.S. Supp. 2020 , Section
	242	+	359), which relates to information to be provided by
	243	+	pharmacy benefits manager; removing exceptions;
	244	+	amending Section 4, Chapter 263, O.S.L. 2014, as
	245	+	amended by Section 8, Chapter 285, O.S.L. 2016 (59
	246	+	O.S. Supp. 2020, Section 360), which relates to
	247	+	contractual duties to providers; modifying
	248	+	reimbursement procedure; prohibit ing placement of
	249	+	drugs on certain list, with exceptions; modifying
	250	+	accreditation or licensing requirement; allowing
	251	+	certain entities to decline to provide services;
	252	+	requiring provision of certain information; and
	253	+	declaring an emergency .
	254	+
	255	+
	256	+
	257	+
50	258
51	259		BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
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52	286		SECTION 1. AMENDATORY 59 O.S. 2011, Section 356.2, is
53	287		amended to read as follows:
54		-
55	288		Section 356.2 A. The entity conducting an audit of a pharmacy
56	289		shall:
57		-
58	290		1. Identify and specifically describe the audit and appeal
59	291		procedures in the pharmacy contract. Unless otherwise agreed to in
60	292		contract by both parties, prescription Prescription claim
61	293		documentation and record -keeping requirements shall not exceed the
62	294		requirements set forth by the Oklahoma P harmacy Act or other
63	295		applicable state or federal laws or regulations;
64		-
65	296		2. For an on-site audit, give Give the pharmacy written notice
66	297		by certified letter to the pharmacy and the pharmacy's contracting
67	298		agent, including identification of specific prescription numbers and
68	299		fill dates to be audited, at least two (2) weeks prior to conducting
69	300		the on-site audit, including, but not limited to, an on -site audit,
70	301		a desk audit, or a wholesale purchase audit, request for
71	302		documentation related to the dispensing of a pre scription drug or
72	303		any reimbursed activity by a pharmacy provider ; provided, however,
73	304		that wholesale purchase audits shall require a minimum of thirty
74		-	(30) days' written notice. The pharmacy shall have the opportunity
	305	+	(30) days written notice . The pharmacy shall have the opportunity
75	306		to reschedule the audit no more than se ven (7) days from the date
76	307		designated on the original audit notification;
77		-
78	308		3. For an on-site audit, not Not interfere with the delivery of
79	309		pharmacist services to a patient and shall utilize every reasonable
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80	336		effort to minimize inconvenience and disruption t o pharmacy
81	337		operations during the audit process;
82		-
83	338		4. Conduct any audit involving clinical or professional
84	339		judgment by means of or in consultation with a licensed pharmacist;
85		-
86	340		5. Not consider as fraud any clerical or record -keeping error,
87	341		such as a typographical error, scrivener's error , or computer error
88	342		regarding a required document or record; however, including, but not
89	343		limited to, a miscalculated day supply , incorrectly billed
90	344		prescription written date or prescription origin code, and such
91	345		errors may shall not be subject to recoupment. The pharmacy shall
92		-	have the right to submit amended claims electronically to correct ~~ENR. H. B. NO. 2677 Page 3~~
	346	+	have the right to submit amended claims electronically to correct
93	347		clerical or record-keeping errors in lieu of recoupment , provided
94	348		that the prescription was dispensed according to prescription
95	349		documentation requirements set forth by the Oklahoma Pharmacy Act .
96	350		To the extent that an audit results in the identification of any
97	351		clerical or record-keeping errors such as typographical errors,
98	352		scrivener's errors or computer errors in a required document or
99	353		record, the pharmacy shall not be subject to recoupment of funds by
100	354		the pharmacy benefits manager unless the pharmacy benefits manager
101	355		can provide proof of intent to commit fraud or such error results in
102	356		actual financial harm to the pharmacy benefits manager, a health
103	357		insurance plan managed by the pharmacy benefits manager or a
104	358		consumer. A person shall not be subject to criminal penalties for
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105	385		errors provided for in this paragraph without proof of intent to
106	386		commit fraud;
107		-
108	387		6. Permit a pharmacy to use the records of a hospital,
109	388		physician, or other authorized practitioner of the healing arts for
110	389		drugs or medicinal supplies written or transmitted by any means of
111	390		communication for purposes of validating the pharmacy record with
112	391		respect to orders or refills of a legend or narcotic drug;
113		-
114	392		7. Base a finding of an overpayment or underpayment on a
115	393		projection based on the number of patients served having similar
116	394		diagnoses or on the number of similar orders or refills for similar
117	395		drugs; provided, recoupment of claims shall be based on the actual
118	396		overpayment or underpayment of each identified claim. A projection
119	397		for overpayment or underpayment may be used to determine recoupment
120	398		as part of a settlement as agreed to by the pharmacy;
121		-
122	399		8. Not include the dispensing fee amount or the actual invoice
123	400		cost of the prescription dispensed in a finding of an overpayment
124	401		audit recoupment unless a prescription was not actually dispensed or
125	402		a physician denied authorization or as otherwise agreed to by
126	403		contract of a dispensing order ;
127		-
128	404		9. 8. Audit each pharmacy under the same identical standards,
129	405		regularity and parameters as other similarly situated pharmacies
130	406		audited by the entity and all pharmacies owned or managed by the
131	407		pharmacy benefits manager conducting or having conducted the audit ;
132	408
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133	434		10. 9. Not exceed two (2) years one (1) year from the date the
134	435		claim was submitted to or adjudicated by a managed care company,
135	436		nonprofit hospital or medical service organization, insurance
136	437		company, third-party payor, pharmacy benefits manager, a health
137		-	program administered by a department of this state, or any entity ~~ENR. H. B. NO. 2677 Page 4~~
	438	+	program administered by a department of this state, or any entity
138	439		that represents the companies, groups, or departments for the period
139	440		covered by an audit;
140		-
141	441		11. 10. Not schedule or initiate an audit during the first
142	442		seven (7) calendar days of any month due to the high volume of
143	443		prescriptions filled in the pharmacy during that time unless
144	444		otherwise consented to by the pharmacy; and
145		-
146	445		12. 11. Disclose to any plan sponsor whose claims were included
147	446		in the audit any money recouped in the audit ; and
148		-
149	447		12. Not require pharmacists to break open packaging labeled
150	448		"for single-patient-use only". Packaging labeled "for single -
151	449		patient-use only" shall be deemed to be the smallest package size
152	450		available.
153		-
154	451		B. 1. Any entity that conducts wholesale purchase review
155	452		during an audit of a pharmacist or pharmacy shall not require the
156	453		pharmacist or pharmacy to provide a full dispensing report.
157	454		Wholesaler invoice reviews shall be limited to verification of
158	455		purchase inventory specific to the pharmacy claims paid by the
159	456		health benefits plan or pharmacy benefits manager conducting the
160	457		audit.
161	458
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162	484		2. Any entity conducting an audit shall not identify or label a
163	485		prescription claim as an audit discrepancy when:
164		-
165	486		a. the National Drug Code for the dispensed drug is in a
166	487		quantity that is a subunit or multiple of the drug
167	488		purchased by the pharmacist or pharmacy as supported
168	489		by a wholesale invoice,
169		-
170	490		b. the pharmacist or pharmacy dispensed the correct
171	491		quantity of the drug according to the prescription,
172	492		and
173		-
174	493		c. the drug dispensed by the pharmacist or pharmac y
175	494		shares all but the last two digits of the National
176	495		Drug Code of the drug reflected on the supplier
177	496		invoice.
178		-
179	497		3. An entity conducting an audit shall accept as evidence,
180	498		subject to validation, to support the validity of a pharmacy claim
181	499		related to a dispensed drug:
182		-	ENR. H. B. NO. 2677 Page 5
183	500		a. redacted copies of supplier invoices in the
184	501		pharmacist's or pharmacy's possession, or
185		-
186	502		b. invoices and any supporting documents from any
187	503		supplier as authorized by federal or state law to
188	504		transfer ownership of the drug acquired by the
189	505		pharmacist or pharmacy.
190		-
191	506		4. An entity conducting an audit shall provide, no later than
192	507		five (5) business days after the date of a request by the pharmacist
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193	534		or pharmacy, all supporting documents the pharmacist's or pharmacy's
194	535		purchase suppliers provided to the health benefits plan issuer or
195	536		pharmacy benefits manager.
196		-
197	537		C. A pharmacy may shall be allowed to provide the pharmacy's
198	538		computerized patterned medical records or the records of a hospital,
199	539		physician, or other authorized practitioner of the healing arts for
200	540		drugs or medicinal supplies written or transmitted by any means of
201	541		communication for purposes of supporting the pharmacy record with
202	542		respect to orders or refills of a legend or narcotic drug.
203		-
204	543		C. D. The entity conducting the audit shall not audit more than
205	544		seventy-five (75) fifty prescriptions, with specific date of
206	545		service, per initial audit calendar year. The annual limit to the
207	546		number of prescription claims audited shall be inclusive of all
208	547		audits, including any prescription -related documentation requests
209	548		from the health insurer, pharmacy benefits manager or any third -
210	549		party company conducting audits on behalf of any health insurer or
211	550		pharmacy benefits manager during a calendar year .
212		-
213	551		D. E. If paper copies of records are requested by the entity
214	552		conducting the audit, the entity shall pay twenty -five cents ($0.25)
215	553		per page to cover the costs incurred by the pharmacy. The entity
216	554		conducting the audit shall provide the pharmacy with accurate
217	555		instructions, including any required form for obtaining
218	556		reimbursement for the copied records.
219	557
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220	583		E. F. The entity conducting the audit shall provide the
221	584		pharmacy with a written report of the audit and shall :
222		-
223	585		1. Deliver a preliminary audit findings report to the pharmacy
224	586		and the pharmacy's contracting agent within ninety (90) forty-five
225	587		(45) calendar days after conclusion of conducting the audit;
226		-	ENR. H. B. NO. 2677 Page 6
227	588		2. Allow the pharmacy at least sixty (60) ninety (90) calendar
228	589		days following receipt of the preliminary audit findings report in
229	590		which to produce documentation to address any discrepan cy found
230	591		during the audit; provided, however, a pharmacy may request an
231	592		extension, not to exceed an additional sixty (60) forty-five (45)
232	593		calendar days;
233		-
234	594		3. Deliver a final audit findings report to the pharmacy and
235	595		the pharmacy's contracting agent signed by the auditor within one
236	596		hundred twenty (120) ten (10) calendar days after receipt of the
237	597		preliminary audit report or final appeal additional documentation
238	598		provided by the pharmacy , as provided for in Section 356.3 of this
239	599		title, whichever is later ;
240		-
241	600		4. Recoup Allow the pharmacy to reverse and resubmit claims
242	601		electronically within thirty (30) days of receipt of the final audit
243	602		report in lieu of the auditing entity recouping discrepant claim
244	603		amounts from the pharmacy ;
245		-
246		-	5. Not recoup any disputed funds until after final internal
	604	+	5. May not recoup any disputed funds until after final internal
247	605		disposition of the audit findings, including the appeals process as
248	606		provided for in Section 356.3 of this title . Unless otherwise
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249	633		agreed by the parties, future payments to the pharmacy may be
250	634		withheld pending finalization of the a udit should the identified
251	635		discrepancy exceed Twenty -five Thousand Dollars ($25,000.00) ; and
252		-
253	636		5. 6. Not accrue interest during the audit and appeal period.
254		-
255	637		F. G. Each entity conducting an audit shall provide a copy of
256	638		the final audit results, and a final audit report upon request,
257	639		after completion of any review process to the plan sponsor.
258		-
259	640		G. H. 1. The full amount of any recoupment on an on-site audit
260	641		shall be refunded to the plan sponsor. Except as provided for in
261	642		paragraph 2 of this subsection, a char ge or assessment for an audit
262	643		shall not be based, directly or indirectly, on amounts recouped.
263		-
264	644		2. This subsection does not prevent the entity conducting the
265	645		audit from charging or assessing the responsible party, directly or
266	646		indirectly, based on amounts r ecouped if both of the following
267	647		conditions are met:
268		-
269	648		a. the plan sponsor and the entity conducting the audit
270	649		have a contract that explicitly states the percentage
271		-	charge or assessment to the plan sponsor, and ENR. H. B. NO. 2677 Page 7
272		-
	650	+	charge or assessment to the plan sponsor, and
273	651		b. a commission to an agent or employee of the entity
274	652		conducting the audit is not based, directly or
275	653		indirectly, on amounts recouped.
276		-
277	654		H. I. Unless superseded by state or federal law, auditors shall
278	655		only have access to previous audit reports on a particular pharmacy
279	656		conducted by the auditing entity for the same pharmacy benefits
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280	683		manager, health plan or insurer. An auditing vendor contracting
281	684		with multiple pharmacy benefits managers or health insurance plans
282	685		shall not use audit reports or other information gained from an
283	686		audit on a particular pharmacy to conduct another audit for a
284	687		different pharmacy benefits manager or health insurance plan.
285		-
286	688		SECTION 2. AMENDATORY 59 O.S. 2011, Section 356.3, is
287	689		amended to read as follows:
288		-
289	690		Section 356.3 A. Each entity conducting an audit shall
290	691		establish a written appeals process under which a pharmacy may
291	692		appeal an unfavorable preliminary audit report and/or final audit
292	693		report to the entity.
293		-
294	694		B. Following an appeal, if the entity finds that an unfavorable
295	695		audit report or any portion thereof is unsubstantiated, the entity
296	696		shall dismiss the audit report or the unsubstantiated portion of the
297	697		audit report without any further action.
298		-
299	698		C. Any final audit report , following the final audit appeal
300	699		period, with a finding of fraud or willful misrepresentat ion shall
301	700		be referred to the district attorney having proper jurisdiction or
302	701		the Attorney General for prosecution upon completion of the appeals
303	702		process.
304		-
305	703		D. This act does not apply to any audit, review or
306	704		investigation that is initiated based on or that i nvolves suspected
307	705		or alleged fraud, willful mispresentation misrepresentation or
308	706		abuse.
309	707
310		-	SECTION 3. AMENDATORY Section 2, Chapter 263, O.S.L.
311		-	2014 (59 O.S. Supp. 2020, Section 358), is amended to read as
312		-	follows:
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313	732
314		-	Section 358. A. In order to provide pharmacy benefits
315		-	management or any of the services included under the definition of
316		-	pharmacy benefits management in this state, a pharmacy benefits ENR. H. B. NO. 2677 Page 8
317		-	manager or any entity acting as one in a contractual or employment
318		-	relationship for a covered entity shall first obtain a license from
319		-	the Oklahoma Insurance Department, and the Department may charge a
320		-	fee for such licensure.
321		-
322		-	B. The Department shall establish, by regulation, licensure
323		-	procedures, required disclosures for pharmacy benefits managers
324		-	(PBMs) and other rules as may be necess ary for carrying out and
325		-	enforcing the provisions of this act. The licensure procedures
326		-	shall, at a minimum, include the completion of an application form
327		-	that shall include the name and address of an agent for service of
328		-	process, the payment of a requisi te fee, and evidence of the
329		-	procurement of a surety bond.
330		-
331		-	C. The Department may subpoena witnesses and information. Its
332		-	compliance officers may take and copy records for investigative use
333		-	and prosecutions. Nothing in this subsection shall limit the Off ice
334		-	of the Attorney General from using its investigative demand
335		-	authority to investigate and prosecute violations of the law.
336		-
337		-	D. The Department may suspend, revoke or refuse to issue or
338		-	renew a license for noncompliance with any of the provisions hereby
339		-	established or with the rules promulgated by the Department; for
340		-	conduct likely to mislead, deceive or defraud the public or the
341		-	Department; for unfair or deceptive business practices or for
342		-	nonpayment of a renewal fee or fine. The Department may also lev y
343		-	administrative fines for each count of which a licensee PBM has been
344		-	convicted in a Department hearing.
345		-
346		-	SECTION 4. AMENDATORY Section 3, Chapter 263, O.S.L.
	733	+	SECTION 3. AMENDATORY Section 3, Chapter 263, O.S.L.
347	734		2014 (59 O.S. Supp. 2020 , Section 359), is amended to read as
348	735		follows:
349		-
350	736		Section 359. Unless otherwise provided by contract, a A
351	737		pharmacy benefits manager shall provide, upon request by the covered
352	738		entity, information regarding the difference in the amount paid to
353	739		providers for prescription services rendered to covered individuals
354	740		and the amount billed by the pharmacy benefits manager to the
355	741		covered entity or plan sponsor to pay for prescription services
356	742		rendered to covered individuals.
357		-
358		-	SECTION 5. AMENDATORY Section 4, Chapter 263, O.S.L.
	743	+	SECTION 4. AMENDATORY Section 4, Chapter 263, O.S.L.
359	744		2014, as amended by Section 8, Chapter 285, O.S.L. 2016 (59 O.S.
360	745		Supp. 2020, Section 360), is amended to read as follows:
361		-	ENR. H. B. NO. 2677 Page 9
362	746		Section 360. A. The pharmacy benefits manager shall, with
363	747		respect to contracts between a pharmacy benefits manager and a
364	748		provider, including a pharmacy service adm inistrative organization :
365		-
366	749		l. Include in such contracts the specific sources utilized to
367	750		determine the maximum allowable cost (MAC) pricing of the pharmacy,
368	751		update MAC pricing at least every seven (7) calendar days, and
369	752		establish a process for providers to readily access the MAC list
370	753		specific to that provider;
371		-
372	754		2. In order to place a drug on the MAC list, ensure that the
373	755		drug is listed as "A" or "B" rated in the most recent version of the
374	756		FDA's Approved Drug Products with Therapeutic Equivalence
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375	783		Evaluations, also known as the Orange Book , or has an "NR" or "NA"
376	784		rating or a similar rating by a nationally recognized reference , and
377	785		the drug is generally available for purchase by pharmacies in the
378	786		state from national or regional wholesalers and is not obsolete;
379		-
380	787		3. Ensure dispensing fees are not included in the calculation
381	788		of MAC price reimbursement to pharmacy providers;
382		-
383	789		4. Provide a reasonable administration appeals procedure to
384	790		allow a provider or, a provider's representative and a pharmacy
385	791		service administrative organization to contest reimbursement amounts
386	792		within ten (10) fourteen (14) business days of the final adjusted
387	793		payment date. The pharmacy benefits manager shall not prevent the
388	794		pharmacy or the pharmacy service administrative organization from
389	795		filing reimbursement appeals in an electronic batch format. The
390	796		pharmacy benefits manager must respond to a provider or, a
391	797		provider's representative and a pharmacy service administrative
392	798		organization who has have contested a reimbursement amount through
393	799		this procedure within ten (10) business days. The pharmacy benefits
394	800		manager must respond in an electronic batch format to reimbursement
395	801		appeals filed in an electronic batch format. The pharmacy benefits
396	802		manager shall not require a pharmacy or pharmacy services
397	803		administrative organization to log into a system to upload
398	804		individual claim appeals or to download individual appeal responses.
399	805		If a price update is warranted, the pharmacy benefits manager shall
400	806		make the change in the reimbursement amount, permit the challenging
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401	833		dispensing pharmacy to reverse and rebill the claim in question, and
402	834		make the reimbursement amount change retroactive and effective for
403	835		each similarly all contracted Oklahoma provider providers; and
404		-
405	836		5. If the a below-cost reimbursement appeal is denied, the PBM
406		-	shall provide the reason for the denial, including the National Drug ~~ENR. H. B. NO. 2677 Page 10~~
	837	+	shall provide the reason for the denial, including the National Drug
407	838		Code number from the specific national or regional wholesalers where
408	839		the drug is generally available for purchase by pharmacies in the
409	840		state at or the dispensing pharmacy at a price below the PBM's
410	841		reimbursement price. If the pharmacy benefits manager cannot
411	842		provide a specific national or regional wholesaler where the drug
412	843		can be purchased by the dispensing pharmacy at a price bel ow the
413	844		pharmacy benefits manager' s reimbursement price, the pharmacy
414	845		benefits manager shall immediately adjust the reimbursement amount,
415	846		permit the dispensing pharmacy to reverse and rebill the claim in
416	847		question, and make the reimbursement amount adjustment retroactive
417	848		and effective for all contrac ted providers.
418		-
419	849		B. The pharmacy benefits manager may shall not place a drug on
420	850		a MAC list, unless there are at least two therapeutically
421	851		equivalent, multiple -source drugs, or at least one generic drug
422	852		available from only one manufacturer, generally available for
423	853		purchase by network dispensing retail pharmacies from national or
424	854		regional wholesalers.
425		-
426	855		C. The pharmacy benefits manager shall not require
427	856		accreditation or licensing of providers , or any entity licensed or
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428	883		regulated by the State Board of Pharmacy , other than by the State
429	884		Board of Pharmacy or other state or federal government entity as a
430	885		condition for participation as a network provider .
431		-
432	886		D. A pharmacy or pharmacist may decline to provide the
433	887		pharmacist clinical or dispensing services to a patient or pharmacy
434	888		benefits manager if the pharmacy or pharmacist is to be paid less
435	889		than the pharmacy's cost for providing the pharmacist clinical or
436	890		dispensing services.
437		-
438	891		E. The pharmacy benefits manager shall provide a dedicated
439	892		telephone number, email address a nd names of the personnel with
440	893		decision-making authority regarding MAC appeals and pricing .
441		-
442		-	SECTION 6. It being immediately necessary for the preservation
	894	+	SECTION 5. It being immediately necessary for the preservation
443	895		of the public peace, health or safety, an emergency is hereby
444	896		declared to exist, by reason whereof this act shall take effect and
445		-	be in full force from and after its passage and approval. ENR. H. B. NO. 2677 Page 11
446		-	Passed the House of Representatives the 27th day of April, 2021.
	897	+	be in full force from and after its passage and approval.
	898	+	Passed the House of Representatives the 10th day of February,
	899	+	2021.
447	900
448	901
449	902
450	903
451	904		Presiding Officer of the House
452	905		of Representatives
453	906
454	907
455		-	Passed the Senate the ~~22nd~~ day of ~~April~~, 2021.
	908	+	Passed the Senate the ___ day of __________, 2021.
456	909
457	910
458	911
459	912
460	913		Presiding Officer of the Senate
461	914
462	915
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463	940
464		-	OFFICE OF THE GOVERNOR
465		-	Received by the Office of the Governor this ____________________
466		-	day of ___________________, 20_______, at _______ o'clock _______ M.
467		-	By: _________________________________
468		-	Approved by the Governor of the State of Oklahoma this _________
469		-	day of ___________________, 20_______, at _______ o'clock _______ M.
470		-
471		-
472		-	_________________________________
473		-	Governor of the State of Oklahoma
474		-
475		-	OFFICE OF THE SECRETARY OF STATE
476		-	Received by the Office of the Secretary of State this __________
477		-	day of ___________________, 20_______, at _______ o'clock _______ M.
478		-	By: _________________________________
479	941