Oklahoma 2022 Regular Session

Oklahoma House Bill HB3514 Compare Versions

Version 1 (Old)

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3		-	SENATE FLOOR VERSION - HB3514 SFLR Page 1
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	3	+	ENGR. H. B. NO. 3514 Page 1 1
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29		-	SENATE FLOOR VERSION
30		-	April 11, 2022
31		-	AS AMENDED
32		-
33	28		ENGROSSED HOUSE
34	29		BILL NO. 3514 By: McEntire of the House
35	30
36	31		and
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38	33		Jett of the Senate
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43	38		[ professions and occupations - pharmacy benefit
44	39		plans - modifying powers of Oklahoma Insurance
45	40		Department - effective date ]
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49	47		BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
50	48		SECTION 1. AMENDATORY 59 O.S. 2021, Section 357,
51	49		is amended to read as follows:
52	50		Section 357. As used in this act:
53	51		1. "Covered entity" mean s:
54	52		a. a nonprofit hospital or medical service organization,
55	53		insurer, health coverage plan or health maintenance
56	54		organization;,
57	55		b. a health program administered by the state in the
58	56		capacity of provider of health coverage;, or
59	57		c. an employer, labor union, o r other entity organized in
60	58		the state that provi des health coverage to covered
61	59		individuals who are employed or reside in the state.
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89	86		This term does not include a health plan that provides coverage onl y
90	87		for accidental injury, specified disease, hospital in demnity,
91	88		disability income, or other limited ben efit health insurance
92	89		policies and contracts that do not include prescription drug
93	90		coverage;
94	91		2. "Covered individual" means a member, participant, enroll ee,
95	92		contract holder or policy holder or beneficiary of a covered entity
96	93		who is provided health coverage by the covered entity. A covered
97	94		individual includes any dependent or other person provided health
98	95		coverage through a policy, contract or plan for a co vered
99	96		individual;
100	97		3. "Department" means the Oklahoma I nsurance Department;
101	98		4. "Maximum allowable cost " or "MAC" means the list of drug
102	99		products delineating the maximum per -unit reimbursement for
103	100		multiple-source prescription drugs, medical product or devi ce;
104	101		5. "Multisource drug product reimbursement" (reimb ursement)
105	102		means the total amount paid to a pharm acy inclusive of any reduction
106	103		in payment to the pharmacy, excluding prescription dispense fees;
107	104		6. "Pharmacy benefits management" means a service provi ded to
108	105		covered entities to facilitate the provision of prescription drug
109	106		benefits to covered individual s within the state, including
110	107		negotiating pricing and other terms with drug manufacturers and
111	108		providers. Pharmacy benefits management may include any or all of
112	109		the following services:
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114		-	SENATE FLOOR VERSION - HB3514 SFLR Page 3
115		-	(Bold face denotes Committee Amendments) 1
	111	+	ENGR. H. B. NO. 3514 Page 3 1
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140	136		a. claims processing, r etail network management and
141	137		payment of claims to pharmacies for prescription drugs
142	138		dispensed to covered individuals,
143	139		b. clinical formulary development and management
144	140		services,
145	141		c. rebate contracting an d administration,
146	142		d. certain patient compliance, therap eutic intervention
147	143		and generic substitution prog rams, or
148	144		e. disease management programs;
149	145		7. "Pharmacy benefits manager" or "PBM" means a person,
150	146		business or other entity that performs pharmacy benefit s management.
151	147		The term includes a person or entity act ing for a PBM in a
152	148		contractual or employment rel ationship in the performance of
153	149		pharmacy benefits management for a managed care company, nonprofit
154	150		hospital, medical service organization, insurance comp any, third-
155	151		party payor, or a health program administere d by an agency of this
156	152		state;
157	153		8. "Plan sponsor" means the employers, insurance companies,
158	154		unions and health maintenance organizations or any other entity
159	155		responsible for establishing, maintaining, or administering a health
160	156		benefit plan on behalf of covere d individuals; and
161	157		9. "Provider" means a pharma cy licensed by the State Board of
162	158		Pharmacy, or an agent or representative of a pharmacy, including,
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164		-	SENATE FLOOR VERSION - HB3514 SFLR Page 4
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190	185		but not limited to, the pharmacy's contracting agent, which
191	186		dispenses prescription drugs or devices to cover ed individuals; and
192	187		10. "Retail pharmacy" or "pharmacy" means a pharmacy, as
193	188		defined in Section 353.1 of this title.
194	189		SECTION 2. AMENDATORY 59 O.S. 2021, Section 358, is
195	190		amended to read as follows:
196	191		Section 358. A. In order to provide phar macy benefits
197	192		management or any of the services included under the definition of
198	193		pharmacy benefits management in this state, a phar macy benefits
199	194		manager or any entity acting as one in a contrac tual or employment
200	195		relationship for a covered entity shall firs t obtain a license from
201	196		the Oklahoma Insurance Department, and the Department may charge a
202	197		fee for such licensure.
203	198		B. The Department shall establish, by regulation, licensure
204	199		procedures, required disclosures for pharmacy benefits managers
205	200		(PBMs) and other rules as may be necessary for carryin g out and
206	201		enforcing the provisions of this act. The licensure procedures
207	202		shall, at a minimum, include the completion of an application form
208	203		that shall include the name and address of an agent for service of
209	204		process, the payment of a requisite fee, and evi dence of the
210	205		procurement of a surety bond.
211	206		C. The Department may subpoena witnesses and info rmation. Its
212	207		compliance officers may take and copy records fo r investigative use
213	208		and prosecutions. Nothing in this subsecti on shall limit the Office
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215		-	SENATE FLOOR VERSION - HB3514 SFLR Page 5
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241	235		of the Attorney General from using its investigative demand
242	236		authority to investigate and prosecute violat ions of the law.
243	237		D. The Department may issue a cease and desist order, place on
244	238		probation, suspend, revoke or refuse to issu e or renew a license for
245	239		noncompliance with any of the provisions hereby established or with
246	240		the rules promulgated by the D epartment; for conduct likely to
247	241		mislead, deceive or defraud th e public or the Department; for unfair
248	242		or deceptive business practices or for nonpayment of a renewal fee
249	243		or fine. The Department may also issue or order a reprimand,
250	244		require restitution, and levy administrative fines not to exceed Ten
251	245		Thousand Dollars ($10,000.00) for each count of which a PBM has been
252	246		convicted in a Depar tment hearing any pharmacy benefits ma nager has
253	247		violated any of the provisions hereby established or with the rules
254	248		promulgated by the Department .
255	249		SECTION 3. AMENDATORY 59 O.S. 2021, Section 360, is
256	250		amended to read as follows:
257	251		Section 360. A. The pharmacy benefits m anager shall, with
258	252		respect to contracts between a pharmacy be nefits manager and a
259	253		provider, including a pharmacy service administrative organization :
260	254		1. Include in such contracts the specific sources utilized to
261	255		determine the maximum allowable cost (MAC) pricing of the pharmacy,
262	256		update MAC pricing at least every se ven (7) calendar days, and
263	257		establish a process for providers to readily access the MAC list
264	258		specific to that provider;
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266		-	SENATE FLOOR VERSION - HB3514 SFLR Page 6
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	260	+	ENGR. H. B. NO. 3514 Page 6 1
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292	285		2. In order to place a drug on the MAC list, ensure that the
293	286		drug is listed as "A" or "B" rated in the most recent version of the
294	287		FDA's Approved Drug Products with Therapeutic Equivalence
295	288		Evaluations, also known as the Orange Book , and the drug is
296	289		generally available for pur chase by pharmacies in the state from
297	290		national or regional wholesalers and is not obsolete;
298	291		3. Ensure dispensing fee s are not included in the calculation
299	292		of MAC price reimbursement to pharmacy providers;
300	293		4. Provide a reasonable administration appeal s procedure to
301	294		allow a provider, a provider's representative and a pharmacy service
302	295		administrative organization to contest reimbursement amounts within
303	296		fourteen (14) business days of the final adjusted payment date . The
304	297		pharmacy benefits manager shall not pr event the pharmacy o r the
305	298		pharmacy service administrative organization from filing
306	299		reimbursement appeals in an electron ic batch format. The pharmacy
307	300		benefits manager must respond to a provider , a provider's
308	301		representative and a pharmacy service administra tive organization
309	302		who have contested a reimbursement amoun t through this procedure
310	303		within ten (10) business days . The pharmacy benefits manager must
311	304		respond in an electronic batch format to reimbursement appeals filed
312	305		in an electronic batch format . The pharmacy benefits man ager shall
313	306		not require a pharmacy or p harmacy services administrative
314	307		organization to log into a sy stem to upload individual claim appeals
315	308		or to download individual appeal responses . If a price update is
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317		-	SENATE FLOOR VERSION - HB3514 SFLR Page 7
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343	335		warranted, the pharmacy benefit s manager shall make the change in
344	336		the reimbursement amoun t, permit the dispensing pharmacy to reverse
345	337		and rebill the claim in question, and make the reimbursement amount
346	338		change retroactive and effective for all contracted providers; and
347	339		5. If a below-cost reimbursement appeal is denied, the PBM
348	340		shall provide the reason for the denial, including the National Drug
349	341		Code number from and the specific national or regional wholesalers
350	342		where from which the drug is was available for purchase by the
351	343		dispensing pharmacy at a price below the PBM's reimbursement price
352	344		as of the date the adjudication of the claim was made. If the
353	345		pharmacy benefits manager cannot fails to provide a specific
354	346		national or regional wholesaler where from which the drug can be
355	347		purchased was available for purchas e by the dispensing pharmacy at a
356	348		price below the pharmacy benefits manager's reimbursement price, the
357	349		pharmacy benefits manag er shall immediately adjust the reimbursement
358	350		amount, permit the di spensing pharmacy to reverse and rebill the
359	351		claim in question, and make the reimbursement amount adju stment
360	352		retroactive and effective for all contracted providers .
361	353		B. The pharmacy benefits manager shall not place a drug on a
362	354		MAC list, unless there are at least two therapeutically equivalent,
363	355		multiple-source drugs, generally available for purchase b y
364	356		dispensing retail pharmacies from national or regional wholesale rs
365	357		which are listed as accre dited drug distributors on the National
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393	384		Association of Boards of Ph armacy (NABP) website or other website as
394	385		recognized and approv ed by the State Board of Pharmacy.
395	386		C. The pharmacy benefits manager shall not require
396	387		accreditation or licensing of provider s, or any entity licensed or
397	388		regulated by the State Board of Pharma cy, other than by the State
398	389		Board of Pharmacy or federal government entity as a condition for
399	390		participation as a network provider.
400	391		D. A pharmacy or pharmacist may decline to provide the
401	392		pharmacist clinical or dispensing services to a patient or pharmacy
402	393		benefits manager if the pharmacy or pharmacist is to be pa id less
403	394		than the pharmacy's cost for providing the pharmacist clinical or
404	395		dispensing services.
405	396		E. The pharmacy benefits manager sha ll provide a dedicated
406	397		telephone number, email address and names of the personnel with
407	398		decision-making authority regarding M AC appeals and pricing.
408	399		SECTION 4. This act shall become effective November 1, 202 2.
409		-	COMMITTEE REPORT BY: COMMITTEE ON RETIREMENT AND INSURANCE
410		-	April 11, 2022 - DO PASS AS AMENDED
	400	+	Passed the House of Representatives the 22nd day of March, 2022.
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	405	+	Presiding Officer of the House
	406	+	of Representatives
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	409	+	Passed the Senate the ___ day of __________, 2022.
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	414	+	Presiding Officer of the Senate