Oklahoma 2022 Regular Session

Oklahoma Senate Bill SB1324 Compare Versions

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Version 2 (New)

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3		-	SB1324 HFLR Page 1
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	3	+	ENGR. S. B. NO. 1324 Page 1 1
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29		-	HOUSE OF REPRESENTATIVES - FLOOR VERSION
30		-
31		-	STATE OF OKLAHOMA
32		-
33		-	2nd Session of the 58th Legislature (2022)
34		-
35		-	COMMITTEE SUBSTITUTE
36		-	FOR ENGROSSED
37		-	SENATE BILL NO. 1324 By: McCortney, Hicks, and
38		-	Pederson of the Senate
	28	+	ENGROSSED SENATE
	29	+	BILL NO. 1324 By: McCortney and Hicks of the
	30	+	Senate
39	31
40	32		and
41	33
42	34		McEntire of the House
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46		-
47		-	COMMITTEE SUBSTITUTE
48		-
49		-	An Act relating to pharmacy benefits man agers;
50		-	amending 36 O.S. 2021, Sections 6960 and 6962, which
51		-	relate to definitions and compliance review; adding
52		-	and modifying definitions; prohibiting certain
53		-	contractual provisions; requiring publicatio n of
54		-	certain formulary information; requiring pharmac y
55		-	benefits managers to provide certain reports;
56		-	requiring certain publication of certain monies
57		-	received by pharmacy benefits managers; providing
58		-	confidentiality of certain records; providing certain
59		-	provisions and compliance measures for defined cost
60		-	sharing; amending 36 O.S . 2021, Section 6964, which
61		-	relates to formulary decisions to identify drugs that
62		-	offer greatest value; modifying requirem ents and
	38	+	[ pharmacy benefits managers - contractual provisions
	39	+	- publication of certain formulary information -
	40	+	confidentiality of certain records - requirements and
63	41		duties for pharmacy and therapeutics committee
64		-	members; amending 51 O.S. 2021, Section 24A.3, which
65		-	relates to open records; exempting certain
66		-	information from open records; amending 59 O.S. 2021,
67		-	Sections 357 and 358, which relate to definiti ons and
68		-	pharmacy benefits management licensure; modifying
69		-	definitions; modifying required information for
70		-	certain application forms; provi ding for
71		-	codification; and providing an effective date.
	42	+	members - codification - effective date ]
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77		-	SB1324 HFLR Page 2
78		-	BOLD FACE denotes Committee Amendments. 1
	48	+	BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
	49	+	SECTION 1. AMENDATORY 36 O.S. 2021, Section 6960, is
	50	+	amended to read as follows:
	51	+	Section 6960. For purposes of the Patient's Right to Pharmacy
	52	+	Choice Act:
	53	+	1. "Administrative fees" means fees or payments from
	54	+	pharmaceutical manufacturers to, or otherwise retained by, a
	55	+	pharmacy benefits manager (PBM) or its designe e pursuant to a
	56	+	contract between a PBM or affiliate and the manufacturer in
	57	+	connection with the PBM's administering, invoicing, allocating, and
	58	+	collecting the rebat es;
	59	+	2. "Aggregate retained rebate percentage" means the percentage
	60	+	of all rebates received by a PBM from all pharmaceutical
	61	+	manufacturers which is not passed on to the PBM's health plan or
	62	+
	63	+	ENGR. S. B. NO. 1324 Page 2 1
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103		-	BE IT ENACTED BY THE PE OPLE OF THE STATE OF OKLAHOMA:
104		-	SECTION 1. AMENDATORY 36 O.S. 2021, Section 6960, is
105		-	amended to read as follows:
106		-	Section 6960. For purposes of the Patient's Right to Pharmacy
107		-	Choice Act:
108		-	1. "Administrative fees" means fees or payments from
109		-	pharmaceutical manufacturers to, or otherwise retained by, a
110		-	pharmacy benefits manager (PBM) or its designee pursuant to a
111		-	contract between a PBM or affiliate and the manufacturer in
112		-	connection with the PBM's administering, invoicing, allocating, and
113		-	collecting the rebat es;
114		-	2. "Aggregate retained rebate percentage" means the percentage
115		-	of all rebates received by a PBM from all pharmaceutical
116		-	manufacturers which is not passed on to the PBM's health plan or
117	88		health insurer clients. The aggregate retained rebate percentage
118	89		shall be expressed without disclosing any identifying information
119	90		regarding any health plan, prescription drug, or therapeutic class,
120	91		and shall be calculated by dividing:
121	92		a. the aggregate dollar amount of all r ebates that the
122	93		PBM received during the prior calendar year from all
123	94		pharmaceutical manufacturers that did not pass through
124	95		to the pharmacy benefits manager's health plan or
125	96		health insurer clients, by
	97	+	b. the aggregate dollar amount of all rebates that the
	98	+	pharmacy benefit manager received during the prior
	99	+	calendar year from all pharmaceutical manufacturers;
	100	+	3. "Defined cost sharing" means a deductible payment or
	101	+	coinsurance amount imposed on an enrollee for a covered prescription
	102	+	drug under the enrollee's health plan;
	103	+	4. "Formulary" means a list of prescription drugs, any
	104	+	prescription drug accompanying tiering, and other coverage
	105	+	information that has been developed by a health insurer or its
	106	+	designee that is referenced in determining applicable coverage and
	107	+	benefit levels;
	108	+	5. "Generic equivalent" means a drug that is designated as
	109	+	therapeutically equivalent by the United States Food and Dru g
	110	+	Administration's "Approved Drug Products with Therapeutic
	111	+	Equivalence Evaluations"; provided, however, a drug shall not be
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127		-	SB1324 HFLR Page 3
128		-	BOLD FACE denotes Committee Amendments. 1
	113	+	ENGR. S. B. NO. 1324 Page 3 1
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153		-	b. the aggregate dollar amount of all rebates that the
154		-	pharmacy benefit manager received during the prior
155		-	calendar year from all pharmaceutical manufacturers;
156		-	3. "Defined cost sharing" means a deductible payment or
157		-	coinsurance amount imposed on an enrollee for a covered prescription
158		-	drug under the enrollee's health plan;
159		-	4. "Formulary" means a list of prescription drugs, any
160		-	prescription drug accompanying tiering, and other coverage
161		-	information that has been developed by a health insurer or its
162		-	designee that is referenced in determining applicable coverage and
163		-	benefit levels;
164		-	5. "Generic equivalent" means a drug that is designated as
165		-	therapeutically equivalent by the United States Food and Drug
166		-	Administration's "Approved Drug Products with Therapeu tic
167		-	Equivalence Evaluations"; provided, however, a drug shall not be
168	138		considered a generic equivalent until the drug becomes nationally
169	139		available;
170	140		6. "Health insurer" means any corporation, associatio n, benefit
171	141		society, exchange, partnership or individual licensed by t he
172	142		Oklahoma Insurance Code;
173	143		7. "Health insurer administrative service fees" means fees or
174	144		payments from a health insurer or its designee to, or otherwise
175	145		retained by, a PBM or its design ee pursuant to a contract between a
176	146		PBM or affiliate and the health insurer or its designee in
	147	+	connection with the PBM 's managing or administering the pharmacy
	148	+	benefit and administering, invoicing, alloc ating, and collecting
	149	+	rebates;
	150	+	8. "Health plan" means a policy, contract, certification, or
	151	+	agreement offered or issued by a health insurer to provide, deliver,
	152	+	arrange for, pay for, or reimburse any of the costs of health
	153	+	services;
	154	+	9. "Insurer" means a health insurer as defined pursu ant to
	155	+	paragraph 6 of this section;
	156	+	2. 10. "Mail-order pharmacy" means a pharmacy licensed by this
	157	+	state that primarily dispenses and delive rs covered drugs via common
	158	+	carrier;
	159	+	3. 11. "Pharmacy benefits manager " or "PBM" means a person
	160	+	that, either directly or through an inte rmediary, performs pharmacy
	161	+	benefits management, as defined by paragraph 6 of Section 357 of
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178		-	SB1324 HFLR Page 4
179		-	BOLD FACE denotes Committee Amendments. 1
	163	+	ENGR. S. B. NO. 1324 Page 4 1
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204		-	connection with the PBM 's managing or administering the pharmacy
205		-	benefit and administering, invoicing, alloc ating, and collecting
206		-	rebates;
207		-	8. "Health plan" means a policy, contract, certification, or
208		-	agreement offered or issued by a health insurer to provide, deliver,
209		-	arrange for, pay for, or reimbu rse any of the costs of health
210		-	services;
211		-	9. "Insurer" means a health insurer as defined pursu ant to
212		-	paragraph 6 of this section;
213		-	2. 10. "Mail-order pharmacy" means a pharmacy licensed by this
214		-	state that primarily dispenses and delive rs covered drugs via common
215		-	carrier;
216		-	3. 11. "Pharmacy benefits manager " or "PBM" means a person
217		-	that, either directly or through an intermediary, performs pharmacy
218		-	benefits management, as defined by paragraph 6 of Section 357 of
219	188		Title 59 of the Oklahoma S tatutes, and any other person acting for
220	189		such person under a contractual or employme nt relationship in the
221	190		performance of pharmacy benefi ts management for a managed-care
222	191		company, nonprofit hospital, medical service organization, insurance
223	192		company, third-party payor or a health program administered by a
224	193		department of this state;
225	194		4. 12. "Pharmacy and therapeutics committee" or "P&T committee"
226	195		means a committee at a hospital or a health insurance plan that
227	196		decides which drugs will appear on that entity 's drug formulary;
	197	+	13. "Price protection rebate" means a negotiated price
	198	+	concession that accrues directly or indirectly to the health insurer
	199	+	or other party on behalf of the health insurer in the event of an
	200	+	increase in the wholesale acquisition cost of a drug above a
	201	+	specified cost threshold;
	202	+	14. "Rebates" means:
	203	+	a. negotiated price concessi ons including but not limited
	204	+	to base price concessio ns, whether described as a
	205	+	rebate or otherwise, and reasonable estimates of any
	206	+	price protection rebates and performa nce-based price
	207	+	concessions that may accrue directly or indirectly to
	208	+	the PBM during the coverage year from a manufacturer,
	209	+	dispensing pharmacy, or other party in connection with
	210	+	the dispensing or administration of a prescription
	211	+	drug, and
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229		-	SB1324 HFLR Page 5
230		-	BOLD FACE denotes Committee Amendments. 1
	213	+	ENGR. S. B. NO. 1324 Page 5 1
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255		-	13. "Price protection rebate" means a negotiated price
256		-	concession that accrues directly or indirectly to the health insurer
257		-	or other party on behalf of the health insurer in the event of an
258		-	increase in the wholesale acquisition cost of a drug above a
259		-	specified cost threshold;
260		-	14. "Rebates" means:
261		-	a. negotiated price concessi ons including but not limited
262		-	to base price concessions, whether described as a
263		-	rebate or otherwise, and reasonable estimates of any
264		-	price protection rebates and performa nce-based price
265		-	concessions that may accrue directly or indirectly to
266		-	the PBM during the coverage year from a manufacturer,
267		-	dispensing pharmacy, or other party in connection with
268		-	the dispensing or administration of a prescription
269		-	drug, and
270	238		b. reasonable estimates of any price concessi ons, fees,
271	239		and other administrative costs that are passed
272	240		through, or are reasonably anticipated to be passed
273	241		through, to the PBM and serve to reduce the PBM's
274	242		liabilities for a prescription drug;
275	243		5. 15. "Retail pharmacy netwo rk" means retail pharmacy
276	244		providers contracted with a PBM in which the pharmacy primar ily
277	245		fills and sells prescriptions via a retail, store front location;
	246	+	6. 16. "Rural service area" means a five-digit ZIP code in
	247	+	which the population density is less than one thousand (1,000)
	248	+	individuals per square mile;
	249	+	7. 17. "Suburban service area " means a five-digit ZIP code in
	250	+	which the population dens ity is between one thousand (1,000) and
	251	+	three thousand (3,000) individuals per square mile; and
	252	+	8. 18. "Urban service area" means a five-digit ZIP code in
	253	+	which the population density is greater than th ree thousand (3,000)
	254	+	individuals per square mile.
	255	+	SECTION 2. AMENDATORY 36 O.S. 2021, Section 6962, is
	256	+	amended to read as follows:
	257	+	Section 6962. A. The Oklahoma Insurance Department shall
	258	+	review and approve retail p harmacy network access for all pharmacy
	259	+	benefits managers (PBMs) t o ensure compliance with Section 4 6961 of
	260	+	this act title.
	261	+	B. A PBM, or an agent of a PBM, shall not:
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279		-	SB1324 HFLR Page 6
280		-	BOLD FACE denotes Committee Amendments. 1
	263	+	ENGR. S. B. NO. 1324 Page 6 1
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305		-	6. 16. "Rural service area" means a five-digit ZIP code in
306		-	which the population density is less than one thousand (1,000)
307		-	individuals per square mile;
308		-	7. 17. "Suburban service area " means a five-digit ZIP code in
309		-	which the population density is between one thousand (1,000) and
310		-	three thousand (3,000) individuals per square mile; and
311		-	8. 18. "Urban service area" means a five-digit ZIP code in
312		-	which the population density is greater than th ree thousand (3,000)
313		-	individuals per square mile.
314		-	SECTION 2. AMENDATORY 36 O.S. 2021, Section 6962, is
315		-	amended to read as follows:
316		-	Section 6962. A. The Oklahoma Insura nce Department shall
317		-	review and approve retail p harmacy network access for all pharmacy
318		-	benefits managers (PBMs) to ensure compliance with Section 4 6961 of
319		-	this act title.
320		-	B. A PBM, or an agent of a PBM, shall not:
321	288		1. Cause or knowingly permit the use of advertisemen t,
322	289		promotion, solicitation, representation, p roposal or offer that is
323	290		untrue, deceptive or misleading;
324	291		2. Charge a pharmacist or pharmacy a fee related to the
325	292		adjudication of a claim, including without limitation a fee for:
326	293		a. the submission of a claim,
327	294		b. enrollment or participation in a retail pha rmacy
328	295		network, or
	296	+	c. the development or management of cla ims processing
	297	+	services or claims payment services related to
	298	+	participation in a retail pharmacy network;
	299	+	3. Reimburse a pharmacy or pharmacist in the st ate an amount
	300	+	less than the amount that the P BM reimburses a pharmacy owned by or
	301	+	under common ownersh ip with a PBM for providing the same covered
	302	+	services. The reimbursement amount paid to the pharmacy shall be
	303	+	equal to the reimbursement amount calculate d on a per-unit basis
	304	+	using the same generic product identifier or generic code number
	305	+	paid to the PBM-owned or PBM-affiliated pharmacy;
	306	+	4. Deny a pharmacy the opportunity to participate in any
	307	+	pharmacy network at preferred participation status if the pha rmacy
	308	+	is willing to accept the terms and cond itions that the PBM has
	309	+	established for other pharmacies as a condition of preferred network
	310	+	participation status;
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330		-	SB1324 HFLR Page 7
331		-	BOLD FACE denotes Committee Amendments. 1
	312	+	ENGR. S. B. NO. 1324 Page 7 1
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356		-	c. the development or m anagement of claims processing
357		-	services or claims payment services related to
358		-	participation in a retail pharmacy network;
359		-	3. Reimburse a pharmacy or pharma cist in the state an amount
360		-	less than the amount that the P BM reimburses a pharmacy owned by or
361		-	under common ownership with a PBM for providing the same covered
362		-	services. The reimbursement amount paid to the pharmacy shall be
363		-	equal to the reimbursement am ount calculated on a per-unit basis
364		-	using the same generic product identifier or generic code number
365		-	paid to the PBM-owned or PBM-affiliated pharmacy;
366		-	4. Deny a pharmacy the opportunity to participate in any
367		-	pharmacy network at preferred participation sta tus if the pharmacy
368		-	is willing to accept the terms and cond itions that the PBM has
369		-	established for other pharmacies as a condition of preferred network
370		-	participation status;
371	337		5. Deny, limit or terminate a pharmacy's contract based on
372	338		employment status of any employee wh o has an active license to
373	339		dispense, despite probation status, with the State Board of
374	340		Pharmacy;
375	341		6. Retroactively deny or reduce reimbursement for a covered
376	342		service claim after returning a paid claim response as part of the
377	343		adjudication of the claim, unle ss:
378	344		a. the original claim was submitted fraud ulently, or
	345	+	b. to correct errors identified in an audit, so long as
	346	+	the audit was conducted in compliance with Sections
	347	+	356.2 and 356.3 of Title 59 of the Oklahoma Statutes;
	348	+	or
	349	+	7. Fail to make any payment due t o a pharmacy or pharmacist for
	350	+	covered services properly rendered in the event a PBM terminates a
	351	+	pharmacy or pharmacist from a pharmacy benefits manager network.
	352	+	C. The prohibitions under this section shall apply to contracts
	353	+	between pharmacy benefits managers an d pharmacists or pharmacies for
	354	+	participation in retail pharmacy networks.
	355	+	1. A PBM contract shall:
	356	+	a. not restrict, directly or indirectly, any pharmacy
	357	+	that dispenses a prescription drug from informing, or
	358	+	penalize such pharmacy for informing, an indivi dual of
	359	+	any differential between the ind ividual's out-of-
	360	+	pocket cost or coverage with respect to acquisition of
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380		-	SB1324 HFLR Page 8
381		-	BOLD FACE denotes Committee Amendments. 1
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406		-	b. to correct errors identifi ed in an audit, so long as
407		-	the audit was conducted in compliance with Sections
408		-	356.2 and 356.3 of Title 59 of the Oklahoma Statutes;
409		-	or
410		-	7. Fail to make any payment due to a pharmacy or pharmacist for
411		-	covered services properly rendered in the event a PBM t erminates a
412		-	pharmacy or pharmacist from a pharmacy benefits manager network.
413		-	C. The prohibitions under this section shall apply to contracts
414		-	between pharmacy benefits managers an d pharmacists or pharmacies for
415		-	participation in retail pharmacy networks.
416		-	1. A PBM contract shall:
417		-	a. not restrict, directly or indirectly, any pharmacy
418		-	that dispenses a prescription drug from informing, or
419		-	penalize such pharmacy f or informing, an indivi dual of
420		-	any differential between the ind ividual's out-of-
421		-	pocket cost or cover age with respect to acquisition of
422	387		the drug and the amount an individual would pay to
423	388		purchase the drug directly, and
424	389		b. ensure that any entity that provides pharmacy benefits
425	390		management services under a contract with a ny such
426	391		health plan or health insurance coverage does not,
427	392		with respect to such plan or coverage, restrict,
428	393		directly or indirectly, a pharmacy that dispenses a
429	394		prescription drug from informing, or penalize such
	395	+	pharmacy for informing, a covered individual of any
	396	+	differential between the individual 's out-of-pocket
	397	+	cost under the plan or coverage with respect to
	398	+	acquisition of the drug and the amount an individual
	399	+	would pay for acquisition of the drug without using
	400	+	any health plan or health insurance coverage ,
	401	+	c. not prohibit from or penalize for a pharmacy or
	402	+	pharmacist disclosing to an individual information
	403	+	regarding the existence and clinical efficacy of a
	404	+	generic equivalent that would be less expensive to the
	405	+	enrollee under his or her health plan prescrip tion
	406	+	drug benefit or outside his or her heal th plan
	407	+	prescription drug benefit, without requesting any
	408	+	health plan reimbursement, than the drug that was
	409	+	originally prescribed, and
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431		-	SB1324 HFLR Page 9
432		-	BOLD FACE denotes Committee Amendments. 1
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450	429		19
451	430		20
452	431		21
453	432		22
454	433		23
455	434		24
456	435
457		-	pharmacy for informing, a covered individual of any
458		-	differential between the indiv idual's out-of-pocket
459		-	cost under the plan or coverage with respect to
460		-	acquisition of the drug and the amount an individual
461		-	would pay for acquisition of the drug without using
462		-	any health plan or health insurance coverage ,
463		-	c. not prohibit from or penalize for a pharmacy or
464		-	pharmacist disclosing to an individual information
465		-	regarding the existence and clinical efficacy of a
466		-	generic equivalent that would be less expensive to the
467		-	enrollee under his or her health plan prescrip tion
468		-	drug benefit or outside his or her health plan
469		-	prescription drug benefit, without requesting any
470		-	health plan reimbursement, than the drug that was
471		-	originally prescribed, and
472	436		d. not prohibit from or penalize for a pharmacy or
473	437		pharmacist selling to an individual, instead of a
474	438		particular prescribed dru g, therapeutically equivalent
475	439		drug that would be less expensive to the enrollee
476	440		under his or her health plan prescription drug benefit
477	441		or outside his or her health plan prescription drug
478	442		benefit, without requesting any health plan
479	443		reimbursement, than the drug that was originally
480	444		prescribed.
	445	+	2. A pharmacy benefits manager's contract with a participating
	446	+	pharmacist or pharmac y shall not prohibit, restrict or limit
	447	+	disclosure of informati on to the Insurance C ommissioner, law
	448	+	enforcement or state and fed eral governmental officials
	449	+	investigating or examining a complaint or conducting a review of a
	450	+	pharmacy benefits manager 's compliance with the requirements under
	451	+	the Patient's Right to Pharmacy Choice Act.
	452	+	3. A pharmacy benefits manager shall establish an d maintain an
	453	+	electronic claim inquiry processing system using the National
	454	+	Council for Prescription Drug Programs' current standards to
	455	+	communicate information to pharmacies submitting clai m inquiries.
	456	+	D. For each of the PBM's contracts or other relation ships with
	457	+	a health plan, a PBM shall publish on an easily accessible website
	458	+	the health plan formulary and timely notification of formulary
	459	+	changes and product exclusions.
481	460
482		-	SB1324 HFLR Page 10
483		-	BOLD FACE denotes Committee Amendments. 1
	461	+	ENGR. S. B. NO. 1324 Page 10 1
484	462		2
485	463		3
486	464		4
487	465		5
488	466		6
489	467		7
490	468		8
491	469		9
492	470		10
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497	475		15
498	476		16
499	477		17
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502	480		20
503	481		21
504	482		22
505	483		23
506	484		24
507	485
508		-	2. A pharmacy benefits manager's contract with a participating
509		-	pharmacist or pharmac y shall not prohibit, restrict or limit
510		-	disclosure of informati on to the Insurance C ommissioner, law
511		-	enforcement or state a nd federal governmental officials
512		-	investigating or examining a complaint or conducting a review of a
513		-	pharmacy benefits manager 's compliance with the requirements under
514		-	the Patient's Right to Pharmacy Choice Act.
515		-	3. A pharmacy benefits manager shall establ ish and maintain an
516		-	electronic claim inquiry processing system using the National
517		-	Council for Prescription Drug Programs' current standards to
518		-	communicate information to pharmacies submitting clai m inquiries.
519		-	D. For each of the PBM's contracts or other re lationships with
520		-	a health plan, a PBM shall publish on an easily accessible website
521		-	the health plan formulary and timely notification of formulary
522		-	changes and product exclusions.
523	486		SECTION 3. NEW LAW A new section of law to be codified
524	487		in the Oklahoma Statutes as Section 6962.1 of Title 36, unless there
525	488		is created a duplication in numbering, reads as follows:
526	489		A. Beginning on November 1, 2022, and on an annual basis
527	490		thereafter, a pharmacy benefits manager (PBM) shall provide the
528	491		Insurance Department with a report containing the following
529	492		information from the prior calendar year as it pertains to pharmacy
530	493		benefits provided by health insurers to enrollees in the stat e:
	494	+	1. The aggregate dollar amount of all rebates that the PBM
	495	+	received from all pharmace utical manufacturers;
	496	+	2. The aggregate dollar amount of all administrative fees that
	497	+	the PBM received;
	498	+	3. The aggregate dollar amount of all issuer administrative
	499	+	service fees that the PBM received;
	500	+	4. The aggregate dollar amount of all rebates t hat the PBM
	501	+	received from all pharmaceutical manufac turers and did not pass
	502	+	through to health plans or health insurers;
	503	+	5. The aggregate dollar amount of all administrative fees that
	504	+	the PBM received from all pharmaceutical manufacturers and did not
	505	+	pass through to health plans or health insurers;
	506	+	6. The aggregate retained rebate percentage; and
	507	+	7. Across all of the pharmacy benefits manager's contractual or
	508	+	other relationships wit h all health plans or health insurers, the
	509	+	highest aggregate retained rebate perc entage, the lowest aggregate
531	510
532		-	SB1324 HFLR Page 11
533		-	BOLD FACE denotes Committee Amendments. 1
	511	+	ENGR. S. B. NO. 1324 Page 11 1
534	512		2
535	513		3
536	514		4
537	515		5
538	516		6
539	517		7
540	518		8
541	519		9
542	520		10
543	521		11
544	522		12
545	523		13
546	524		14
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548	526		16
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551	529		19
552	530		20
553	531		21
554	532		22
555	533		23
556	534		24
557	535
558		-	1. The aggregate dollar amount of all rebates that the PBM
559		-	received from all pharmaceutical manufacturers;
560		-	2. The aggregate dollar amount of all administrative fees that
561		-	the PBM received;
562		-	3. The aggregate dollar amount of all issuer administrative
563		-	service fees that the PBM received;
564		-	4. The aggregate dollar amount of all rebates that the PBM
565		-	received from all pharmaceutical manufacturers and did not pass
566		-	through to health plans or health insurers;
567		-	5. The aggregate dollar amount of all administrative fees that
568		-	the PBM received from all pharmaceutical manufacturers and did not
569		-	pass through to health plans or health insurers;
570		-	6. The aggregate retained rebate percentage; and
571		-	7. Across all of the pharmacy benefits manager's contractual or
572		-	other relationships wit h all health plans or health insurers, the
573		-	highest aggregate retained rebate percentage, the lowest aggregate
574	536		retained rebate percentage, and the mean aggregate retained rebate
575	537		percentage.
576	538		B. The Department shall publi sh in a timely manner the
577	539		information that it receives under subsection A of this section on a
578	540		publicly available website, provided that such information shall be
579	541		made available in a form that does not disclose the identity of a
580	542		specific health plan or the identity of a specific manufacturer, the
	543	+	prices charged for specific drugs or classes of drugs, or t he amount
	544	+	of any rebates provided for specific drugs or classes of drugs.
	545	+	C. The PBM and the Department shall not publish or otherwise
	546	+	disclose any information that would disclose the identity of a
	547	+	specific health plan, any prices charged for a specific d rug or
	548	+	class of drugs, the amount of any rebates provided for a specific
	549	+	drug or class of drugs, the manufacturer, or information that would
	550	+	otherwise have the potential to compromise the financ ial,
	551	+	competitive, or proprietary nature of the information. The
	552	+	information shall be protected from direct or indirect disclosure as
	553	+	confidential and proprietary information and shall not be deemed a
	554	+	public record as defined pursuant to Section 24A.3 of Title 51 of
	555	+	the Oklahoma Statutes. A PBM shall impose the confident iality
	556	+	protections of this section on any vendor or downst ream third party
	557	+	that performs health care or administrative services o n behalf of
	558	+	the PBM that may receive or have access to rebate information.
581	559
582		-	SB1324 HFLR Page 12
583		-	BOLD FACE denotes Committee Amendments. 1
	560	+	ENGR. S. B. NO. 1324 Page 12 1
584	561		2
585	562		3
586	563		4
587	564		5
588	565		6
589	566		7
590	567		8
591	568		9
592	569		10
593	570		11
594	571		12
595	572		13
596	573		14
597	574		15
598	575		16
599	576		17
600	577		18
601	578		19
602	579		20
603	580		21
604	581		22
605	582		23
606	583		24
607	584
608		-	prices charged for specific drugs or classes of drugs, or t he amount
609		-	of any rebates provided for specific drugs or classes of drugs.
610		-	C. The PBM and the Department shall not publish or otherwise
611		-	disclose any information that would disclose the identity of a
612		-	specific health plan, any prices charged for a specific d rug or
613		-	class of drugs, the amount of any rebates provided for a specific
614		-	drug or class of drugs, the manufacturer, or information that would
615		-	otherwise have the potential to compromise the financ ial,
616		-	competitive, or proprietary nature of the information. The
617		-	information shall be protected from direct or indirect disclosure as
618		-	confidential and proprietary information and shall not be deemed a
619		-	public record as defined pursuant to Section 24A.3 of Title 51 of
620		-	the Oklahoma Statutes. A PBM shall impose the confi dentiality
621		-	protections of this section on any vendor or downstream third party
622		-	that performs health care or administrative services o n behalf of
623		-	the PBM that may receive or have access to rebate information.
624	585		SECTION 4. NEW LAW A new sec tion of law to be codified
625	586		in the Oklahoma Statutes as Sec tion 6962.2 of Title 36, unless there
626	587		is created a duplication in numbering, reads as follows:
627	588		A. An enrollee's defined cost sharing , as defined pursuant to
628	589		Section 6960 of Title 36 of the Oklahoma Statutes , for each
629	590		prescription drug shall be calculated at the point of sale based on
630	591		a price that is reduced by an amount equal to one hundred percent
	592	+	(100%) of all rebates received, or to be received, in connect ion
	593	+	with the dispensing or administration of the prescription drug.
	594	+	B. For any violation of this section, the Insurance
	595	+	Commissioner may subject a pharmacy benefits manager (PBM) to an
	596	+	administrative penalty not less than One Hundred Dollars ( $100.00),
	597	+	nor more than Five Thousand Dollars ($5,000.00) for each occurrence.
	598	+	Such administrative penalt y may be enforced in the same manner in
	599	+	which civil judgments may be enforced.
	600	+	C. Nothing in this section shall preclude a PBM from decreasing
	601	+	an enrollee's defined cost sharing by an amount greater than that
	602	+	required under subsection A of this section.
	603	+	D. In complying with the pr ovisions of this section, a PBM or
	604	+	its agents shall not publish or otherwi se disclose information
	605	+	regarding the actual amount of rebate s a PBM receives on a product
	606	+	or therapeutic class of products, manufacturer, or pharmacy-specific
	607	+	basis. Such information is protected as a trade secret, is not a
	608	+	public record as defined pursuant to Section 24A.3 of Title 51 of
631	609
632		-	SB1324 HFLR Page 13
633		-	BOLD FACE denotes Committee Amendments. 1
	610	+	ENGR. S. B. NO. 1324 Page 13 1
634	611		2
635	612		3
636	613		4
637	614		5
638	615		6
639	616		7
640	617		8
641	618		9
642	619		10
643	620		11
644	621		12
645	622		13
646	623		14
647	624		15
648	625		16
649	626		17
650	627		18
651	628		19
652	629		20
653	630		21
654	631		22
655	632		23
656	633		24
657	634
658		-	(100%) of all rebates received, or to be received, in connect ion
659		-	with the dispensing or administration of the prescription drug.
660		-	B. For any violation of this section, the Insurance
661		-	Commissioner may subject a pharmacy benefits manager (PBM) to an
662		-	administrative penalty not less than One Hundred Dollars ( $100.00),
663		-	nor more than Five Thousand Dollars ($5,000.00) for each occurrence.
664		-	Such administrative penalty may be enforced in the same manner in
665		-	which civil judgments may be enforced.
666		-	C. Nothing in this section shall preclude a PBM from decreasing
667		-	an enrollee's defined cost sharing by an amount greater than that
668		-	required under subsection A of this section.
669		-	D. In complying with the provisions of this section, a PBM or
670		-	its agents shall not publish or otherwise disclose information
671		-	regarding the actual amount of rebate s a PBM receives on a product
672		-	or therapeutic class of products, manufacturer, or pharmacy-specific
673		-	basis. Such information is protected as a trade secret, is not a
674		-	public record as defined pursuant to Section 24A.3 of Title 51 of
675	635		the Oklahoma Statutes, and shall not be disclosed directly or
676	636		indirectly, or in a manner that would allow for the identification
677	637		of an individual product, therapeutic class of products, or
678	638		manufacturer, or in a manner that would have the potential to
679	639		compromise the financial, competitive, or proprietary nature of the
680	640		information. A PBM shall impose the confidentiality protections of
681	641		this section on any vendor or downstream third party that performs
	642	+	health care or administrative services on behalf of the insurer that
	643	+	may receive or have access to rebate information.
	644	+	SECTION 5. NEW LAW A new section of law to be codified
	645	+	in the Oklahoma Statutes as Section 6962.3 of Title 36, unless there
	646	+	is created a duplication in numb ering, reads as follows:
	647	+	A. An enrollee's defined cost sharing, as defined pursuant to
	648	+	Section 6960 of Title 36 of the Oklahoma Statutes , for each
	649	+	prescription drug shall be calculated at the point of sale based on
	650	+	a price that is reduced by an amount equal to one hundred percent
	651	+	(100%) of all rebates received or to be received in connection with
	652	+	the dispensing or administration of the prescription drug.
	653	+	B. For any violation of this section, the Insurance
	654	+	Commissioner may subject an insurer to an administrative penalty not
	655	+	less than One Hundred Dollars ($100.00), nor more than Five Thousand
	656	+	Dollars ($5,000.00) for each occurrence. Such administrative
	657	+	penalty may be enforced in the same manner in which civil judgments
	658	+	may be enforced.
682	659
683		-	SB1324 HFLR Page 14
684		-	BOLD FACE denotes Committee Amendments. 1
	660	+	ENGR. S. B. NO. 1324 Page 14 1
685	661		2
686	662		3
687	663		4
688	664		5
689	665		6
690	666		7
691	667		8
692	668		9
693	669		10
694	670		11
695	671		12
696	672		13
697	673		14
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699	675		16
700	676		17
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702	678		19
703	679		20
704	680		21
705	681		22
706	682		23
707	683		24
708	684
709		-	health care or administrative services on behalf of the insurer that
710		-	may receive or have access to rebate information.
711		-	SECTION 5. NEW LAW A new section of law to be codified
712		-	in the Oklahoma Statutes as Section 6962.3 of Title 36, unless there
713		-	is created a duplication in numb ering, reads as follows:
714		-	A. An enrollee's defined cost sharing, as defined pursuant to
715		-	Section 6960 of Title 36 of the Oklahoma Statutes, for each
716		-	prescription drug shall be calculated at the point of sale based on
717		-	a price that is reduced by an amount equal to one hundred percent
718		-	(100%) of all rebates received or to be received in connection with
719		-	the dispensing or administration of the prescription drug.
720		-	B. For any violation of this section, the Insurance
721		-	Commissioner may subject an insurer to an administrative penalty not
722		-	less than One Hundred Dollars ($100.00), nor more than Five Thousand
723		-	Dollars ($5,000.00) for each occurrence. Such administrative
724		-	penalty may be enforced in the same manner in which civil judgments
725		-	may be enforced.
726	685		C. Nothing in this section shall preclude an insurer from
727	686		decreasing an enrollee 's defined cost sharing by an a mount greater
728	687		than that required under subsection B of this section.
729	688		D. An insurer or its agents shall not publish or otherwise
730	689		disclose information regarding the act ual amount of rebates an
731	690		insurer receives on a product or therapeutic class of produc ts,
732	691		manufacturer, or pharmacy-specific basis. Such information is
	692	+	protected as a trade secret, is not a public record pursuant to
	693	+	Section 24A.3 of Title 51 of the Oklahom a Statutes, and shall not be
	694	+	disclosed directly or indirectly or in a manner that woul d allow for
	695	+	the identification of an individual product, therapeutic class of
	696	+	products, or manufacturer, or in a manner that would have the
	697	+	potential to compromise the fi nancial, competitive, or proprietary
	698	+	nature of the information. The confidentiality pr otections provided
	699	+	in this section shall apply to any vendor or downstream third pa rty
	700	+	that performs healthcare or administrative services on behalf of the
	701	+	insurer that may receive or have access to rebate information.
	702	+	SECTION 6. AMENDATORY 36 O.S. 2021, Section 6964, is
	703	+	amended to read as follows:
	704	+	Section 6964. A. A health insurer's pharmacy and therapeutics
	705	+	committee (P&T committee) of a health insurer or its agent including
	706	+	pharmacy benefits managers, shall establish a formulary , which shall
	707	+	be a list of prescription drugs, both generic and brand name , used
733	708
734		-	SB1324 HFLR Page 15
735		-	BOLD FACE denotes Committee Amendments. 1
	709	+	ENGR. S. B. NO. 1324 Page 15 1
736	710		2
737	711		3
738	712		4
739	713		5
740	714		6
741	715		7
742	716		8
743	717		9
744	718		10
745	719		11
746	720		12
747	721		13
748	722		14
749	723		15
750	724		16
751	725		17
752	726		18
753	727		19
754	728		20
755	729		21
756	730		22
757	731		23
758	732		24
759	733
760		-	protected as a trade secret, is not a public record pursuant to
761		-	Section 24A.3 of Title 51 of the Oklahom a Statutes, and shall not be
762		-	disclosed directly or indirectly or in a manner that would allow for
763		-	the identification of an individual product, th erapeutic class of
764		-	products, or manufacturer, or in a manner that would have the
765		-	potential to compromise the fi nancial, competitive, or proprietary
766		-	nature of the information. The confidentiality protections provided
767		-	in this section shall apply to any vendor or downstream third pa rty
768		-	that performs healthcare or administrative services on behalf of the
769		-	insurer that may receive or have access to rebate information.
770		-	SECTION 6. AMENDATORY 36 O.S. 2021, Section 6964, is
771		-	amended to read as follows:
772		-	Section 6964. A. A health insurer's pharmacy and therapeutics
773		-	committee (P&T committee) of a health insurer or its agent including
774		-	pharmacy benefits managers, shall establish a formulary, which shall
775		-	be a list of prescription drugs, both gene ric and brand name, used
776	734		by practitioners to identify drugs that offer the greatest overall
777	735		value. The P&T committee shall review the formulary annually.
778	736		B. A health insurer shall prohibit confl icts of interest for
779	737		members of the P&T committee. The P&T committee shall meet the
780	738		following requirements:
781	739		1. A person may not serve on a P&T committee if the person is
782	740		currently employed or was employe d within the preceding year by a
	741	+	pharmaceutical manufac turer, developer, labeler, wholesaler or
	742	+	distributor.;
	743	+	2. A majority of P&T committee members shall be practicing
	744	+	physicians, practicing pharmacists, or both, and shall be licensed
	745	+	in this state;
	746	+	2. 3. A health insurer shall require any member of the P&T
	747	+	committee to disclose any compensation or funding from a
	748	+	pharmaceutical manufacturer, developer, labeler, wholesaler or
	749	+	distributor. Such P&T committee member shall be recuse d from voting
	750	+	on any product manufactured or so ld by such pharmaceutical
	751	+	manufacturer, developer, labeler, wholesaler or distributor.;
	752	+	4. P&T committee members shall practice in various clinical
	753	+	specialties that adequately represent the needs of the health plan
	754	+	enrollees and there shall be an adequate numbe r of high-volume
	755	+	specialists and specialists treating rare or orphan diseases ;
	756	+	5. The P&T committee shall meet at least on a quarterly basis;
783	757
784		-	SB1324 HFLR Page 16
785		-	BOLD FACE denotes Committee Amendments. 1
	758	+	ENGR. S. B. NO. 1324 Page 16 1
786	759		2
787	760		3
788	761		4
789	762		5
790	763		6
791	764		7
792	765		8
793	766		9
794	767		10
795	768		11
796	769		12
797	770		13
798	771		14
799	772		15
800	773		16
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803	776		19
804	777		20
805	778		21
806	779		22
807	780		23
808	781		24
809	782
810		-	pharmaceutical manufacturer, developer, labeler, wholesaler or
811		-	distributor.;
812		-	2. A majority of P&T committee members shall be practicing
813		-	physicians, practicing pharmacists, or both, and shall be licensed
814		-	in this state;
815		-	2. 3. A health insurer shall require any member of the P&T
816		-	committee to disclose any compensation or funding from a
817		-	pharmaceutical manufacturer, developer, labeler, wholesaler or
818		-	distributor. Such P&T committee member shall be recuse d from voting
819		-	on any product manufactured or so ld by such pharmaceutical
820		-	manufacturer, developer, labeler, wholesaler or distributor;
821		-	4. P&T committee members shall practice in various clinical
822		-	specialties that adequately represent the needs of the health plan
823		-	enrollees and there shall be an adequate numbe r of high-volume
824		-	specialists and specialists treating rare or orphan diseases;
825		-	5. The P&T committee shall meet at least on a quarterly basis;
826	783		6. P&T committee formulary development shall be conducted
827	784		pursuant to a transparent process, and formulary decisions and
828	785		rationale shall be documented in writing. Upon request, the records
829	786		and documents shall be made available to the health plan, subject to
830	787		the conditions in subsection C of this section;
831	788		7. If the P&T committee relies upon any third party to provide
832	789		cost-effectiveness analysis or research for a Medicaid Managed Care
833	790		organization's prescription drug policy , the P&T committee shall:
	791	+	a. disclose to the health benefit plan, the President Pro
	792	+	Tempore of the Senate, the Speaker of the House of
	793	+	Representatives, and the Governor, the name of a
	794	+	relevant third party, and
	795	+	b. provide a process through which patients and providers
	796	+	potentially impacted by the third party's analysis or
	797	+	research may provide input to the P&T committee;
	798	+	8. P&T committee members who are s pecialists with current
	799	+	clinical expertise and actively treat patients in a specifi c
	800	+	therapeutic area, and the specific conditions within a therapeutic
	801	+	area, shall participate in formulary decisions regarding each
	802	+	therapeutic area and specific condit ion;
	803	+	9. The P&T committee shall base its clinical decisions on the
	804	+	strength of scientifi c evidence, standards of practice, and
	805	+	nationally accepted treatment guidelines;
834	806
835		-	SB1324 HFLR Page 17
836		-	BOLD FACE denotes Committee Amendments. 1
	807	+	ENGR. S. B. NO. 1324 Page 17 1
837	808		2
838	809		3
839	810		4
840	811		5
841	812		6
842	813		7
843	814		8
844	815		9
845	816		10
846	817		11
847	818		12
848	819		13
849	820		14
850	821		15
851	822		16
852	823		17
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854	825		19
855	826		20
856	827		21
857	828		22
858	829		23
859	830		24
860	831
861		-	a. disclose to the health benefit plan, the President Pro
862		-	Tempore of the Senate, the Speaker of the House of
863		-	Representatives, and the Governor, the name of a
864		-	relevant third party, and
865		-	b. provide a process through which patients and providers
866		-	potentially impacted by the third party's analysis or
867		-	research may provide input to the P&T committee;
868		-	8. P&T committee members who are s pecialists with current
869		-	clinical expertise and actively treat patients in a specific
870		-	therapeutic area, and the specific conditions within a therapeutic
871		-	area, shall participate in formulary decisions regarding each
872		-	therapeutic area and specific condit ion;
873		-	9. The P&T committee shall base its clinical decisions on the
874		-	strength of scientific evidence, standards of practice, and
875		-	nationally accepted treatment guidelines;
876	832		10. The P&T committee shall consider whether a particular drug
877	833		has a clinically meaningful therapeutic advantage over other drugs
878	834		in terms of safety, effectiveness, or clinica l outcome for patient
879	835		populations who may be treated with the drug;
880	836		11. The P&T committee shall evaluate and analyze treatment
881	837		protocols and procedures related to the health p lan's formulary at
882	838		least annually;
883	839		12. The P&T committee shall review formulary management
884	840		activities including exceptions and appeals processes, prior
	841	+	authorization, step therapy, quantity limits, generic substitutions,
	842	+	therapeutic interchange, and other drug utilization management
	843	+	activities for clinical appropriateness and consistency with
	844	+	industry standards and patient and provider organization guidelines;
	845	+	13. The P&T committee shall annually review and provide a
	846	+	written report to the pharmacy benefits manager on:
	847	+	a. the percentage of prescription drugs on a formulary
	848	+	subject to each of the types of utilization management
	849	+	described in paragraph 10 of this subsection,
	850	+	b. rates of adherence and nonadherence to medicines by
	851	+	therapeutic area,
	852	+	c. rates of abandonment of medicines by therapeutic area,
	853	+	d. recommendations for improved adherence and reduced
	854	+	abandonment, and
885	855
886		-	SB1324 HFLR Page 18
887		-	BOLD FACE denotes Committee Amendments. 1
	856	+	ENGR. S. B. NO. 1324 Page 18 1
888	857		2
889	858		3
890	859		4
891	860		5
892	861		6
893	862		7
894	863		8
895	864		9
896	865		10
897	866		11
898	867		12
899	868		13
900	869		14
901	870		15
902	871		16
903	872		17
904	873		18
905	874		19
906	875		20
907	876		21
908	877		22
909	878		23
910	879		24
911	880
912		-	authorization, step therapy, quantity limits, generic substitutions,
913		-	therapeutic interchange, and other drug utilization management
914		-	activities for clinical appropriateness and consistency with
915		-	industry standards and patient and provider organization guidelines;
916		-	13. The P&T committee shall annually review and provide a
917		-	written report to the pharmacy benefits manager on:
918		-	a. the percentage of prescription drugs o n a formulary
919		-	subject to each of the types of utilization management
920		-	described in paragraph 10 of this subsection,
921		-	b. rates of adherence and nonadherence to medicines by
922		-	therapeutic area,
923		-	c. rates of abandonment of medicines by therapeutic area,
924		-	d. recommendations for improved adherence and reduced
925		-	abandonment, and
926	881		e. recommendations for improvement in formulary
927	882		management practices consistent with patient and
928	883		provider organization and other clinical g uidelines,
929	884		provided that the report shall be subject to the
930	885		conditions in subsect ion C of this section; and
931	886		14. The P&T committee shall review and make a formulary
932	887		decision on a new U.S. Food and Drug Administration-approved drug
933	888		within ninety (90) days of the drug's approval, or shall provide a
934	889		clinical justification if this timeframe is not met.
	890	+	C. The health insurer, its agents including pharmacy benefits
	891	+	managers, and the Insurance Department shall not publish or
	892	+	otherwise disclose any confident ial, proprietary information
	893	+	including but not limited to any information that w ould disclose the
	894	+	identity of a specific health plan , the price or prices charged for
	895	+	a specific drug or class of dru gs, the amount of any rebates
	896	+	provided for a specific drug or class of drugs, the manufacturer, or
	897	+	that would otherwise have the potential to compromise the financial,
	898	+	competitive, or proprietary nature of the information. The
	899	+	information shall be protected from direct or indirect disclosure as
	900	+	confidential and proprietary information and shall not be deemed a
	901	+	public record as defined pursuant to Section 24A .3 of Title 51 of
	902	+	the Oklahoma Statutes. The confidentiality protections provided in
	903	+	this section shall apply to any vendor or third party that performs
	904	+	health care or administrative services on behalf of the pharmacy
935	905
936		-	SB1324 HFLR Page 19
937		-	BOLD FACE denotes Committee Amendments. 1
	906	+	ENGR. S. B. NO. 1324 Page 19 1
938	907		2
939	908		3
940	909		4
941	910		5
942	911		6
943	912		7
944	913		8
945	914		9
946	915		10
947	916		11
948	917		12
949	918		13
950	919		14
951	920		15
952	921		16
953	922		17
954	923		18
955	924		19
956	925		20
957	926		21
958	927		22
959	928		23
960	929		24
961	930
962		-	C. The health insurer, its agents including pharmacy benefits
963		-	managers, and the Insurance Department shall not publish or
964		-	otherwise disclose any confident ial, proprietary information
965		-	including but not limited to any information that would disclose the
966		-	identity of a specific health plan , the price or prices charged for
967		-	a specific drug or class of dru gs, the amount of any rebates
968		-	provided for a specific drug or class of drugs, the manufacturer, or
969		-	that would otherwise h ave the potential to compromise the financial,
970		-	competitive, or proprietary nature of the information. The
971		-	information shall be protected from direct or indirect disclosure as
972		-	confidential and proprietary information and shall not be deemed a
973		-	public record as defined pursuant to Section 24A.3 of Title 51 of
974		-	the Oklahoma Statutes. The confidentiality protections provided in
975		-	this section shall apply to any vendor or third party that performs
976		-	health care or administrative services on behalf of the pharmacy
977	931		benefits manager that may receive or have access to rebate
978	932		information.
979	933		SECTION 7. AMENDATORY 51 O.S. 2021, Section 24A.3, is
980	934		amended to read as follows:
981	935		Section 24A.3. As used in the Oklahoma O pen Records Act:
982	936		1. "Record" means all documents, including, but not limited to,
983	937		any book, paper, photogra ph, microfilm, data files created by or
984	938		used with computer software, computer tape, disk, record, sound
985	939		recording, film recording, video record or ot her material regardless
	940	+	of physical form or characteristic, created by, received by , under
	941	+	the authority of, or coming into the custody, control or possession
	942	+	of public officials, publi c bodies, or their representatives in
	943	+	connection with the transaction o f public business, the expenditure
	944	+	of public funds or the administering of public p roperty. "Record"
	945	+	Record does not mean:
	946	+	a. computer software,
	947	+	b. nongovernment personal effects,
	948	+	c. unless public disclosure is required by other laws or
	949	+	regulations, vehicle movement records of the Oklahoma
	950	+	Transportation Authority obtained in connection with
	951	+	the Authority's electronic toll collection system,
	952	+	d. personal financial information, credit reports or
	953	+	other financial data obtained by or submitted to a
	954	+	public body for the purpose of evaluating credit
986	955
987		-	SB1324 HFLR Page 20
988		-	BOLD FACE denotes Committee Amendments. 1
	956	+	ENGR. S. B. NO. 1324 Page 20 1
989	957		2
990	958		3
991	959		4
992	960		5
993	961		6
994	962		7
995	963		8
996	964		9
997	965		10
998	966		11
999	967		12
1000	968		13
1001	969		14
1002	970		15
1003	971		16
1004	972		17
1005	973		18
1006	974		19
1007	975		20
1008	976		21
1009	977		22
1010	978		23
1011	979		24
1012	980
1013		-	of physical form or characteristic, created by, received by , under
1014		-	the authority of, or coming into the custody, control or possession
1015		-	of public officials, publi c bodies, or their representatives in
1016		-	connection with the transaction of public business, the expenditure
1017		-	of public funds or the administering of public p roperty. "Record"
1018		-	Record does not mean:
1019		-	a. computer software,
1020		-	b. nongovernment personal effects,
1021		-	c. unless public disclosure is required by other laws or
1022		-	regulations, vehicle movement records of the Oklahoma
1023		-	Transportation Authority obtained in connection with
1024		-	the Authority's electronic toll collection system,
1025		-	d. personal financial information, credit reports or
1026		-	other financial data obtained by or submitted to a
1027		-	public body for the purpose of evaluating credit
1028	981		worthiness, obtaining a license, permit, or for the
1029	982		purpose of becoming quali fied to contract with a
1030	983		public body,
1031	984		e. any digital audio/video recordings of the toll
1032	985		collection and safeguarding activities of the Oklahoma
1033	986		Transportation Authority,
1034	987		f. any personal information provided by a guest at any
1035	988		facility owned or operated by the Oklahoma Tourism and
1036	989		Recreation Department or the Board of Trustees of for
	990	+	the Quartz Mountain Arts and Conference Center and
	991	+	Nature Park to obtain any service at the facility or
	992	+	by a purchaser of a product sold by or through the
	993	+	Oklahoma Tourism and Recr eation Department or the
	994	+	Quartz Mountain Arts and Conference Center and Nature
	995	+	Park,
	996	+	g. a Department of Defense Form 214 (DD Form 214) filed
	997	+	with a county clerk, including any DD Form 214 filed
	998	+	before July 1, 2002, or
	999	+	h. except as provided for in Section 2 -110 of Title 47 of
	1000	+	the Oklahoma Statutes,
	1001	+	(1) any record in connection with a Motor Vehicle
	1002	+	Report issued by the Department of Public Safety,
	1003	+	as prescribed in Section 6-117 of Title 47 of the
	1004	+	Oklahoma Statutes, or
1037	1005
1038		-	SB1324 HFLR Page 21
1039		-	BOLD FACE denotes Committee Amendments. 1
	1006	+	ENGR. S. B. NO. 1324 Page 21 1
1040	1007		2
1041	1008		3
1042	1009		4
1043	1010		5
1044	1011		6
1045	1012		7
1046	1013		8
1047	1014		9
1048	1015		10
1049	1016		11
1050	1017		12
1051	1018		13
1052	1019		14
1053	1020		15
1054	1021		16
1055	1022		17
1056	1023		18
1057	1024		19
1058	1025		20
1059	1026		21
1060	1027		22
1061	1028		23
1062	1029		24
1063	1030
1064		-	the Quartz Mountain Arts and Conference Center and
1065		-	Nature Park to obtain any service at the facility or
1066		-	by a purchaser of a product sold by or through the
1067		-	Oklahoma Tourism and Recr eation Department or the
1068		-	Quartz Mountain Arts and Conference Center and Nature
1069		-	Park,
1070		-	g. a Department of Defense Form 214 (DD Fo rm 214) filed
1071		-	with a county clerk, including any DD Form 214 filed
1072		-	before July 1, 2002, or
1073		-	h. except as provided for in Section 2 -110 of Title 47 of
1074		-	the Oklahoma Statutes,
1075		-	(1) any record in connection with a Motor Vehicle
1076		-	Report issued by the Department of Public Safety,
1077		-	as prescribed in Section 6-117 of Title 47 of the
1078		-	Oklahoma Statutes, or
1079	1031		(2) personal information within driver re cords, as
1080	1032		defined by the Driver's Privacy Protection Act,
1081	1033		18 United States Cod e, Sections 2721 through
1082	1034		2725, which are stored and maintained b y the
1083	1035		Department of Public Safety, or
1084	1036		i. for the purposes of the Patient's Right to Pharmacy
1085	1037		Choice Act, any information or record that would have
1086	1038		the potential to compr omise the financial,
1087	1039		competitive, or proprietary nature of information
	1040	+	about a specific drug or class of drugs, or a specific
	1041	+	product or therapeutic class of products. Additional
	1042	+	information that shall not be disclosed includes but
	1043	+	is not limited to:
	1044	+	(1) any information relating to specific drugs or
	1045	+	classes of drugs that would disclose the identity
	1046	+	of a specific health plan, drug prices, the
	1047	+	rebate amount received by a pharmacy benefits
	1048	+	manager, the rebate amount received by the
	1049	+	insurer, or the identity of the manufacturer, and
	1050	+	(2) any information relating to a product or
	1051	+	therapeutic class of products that would disclose
	1052	+	the rebate received by a pharmacy benefits
	1053	+	manager, the rebate amount received by an
	1054	+	insurer, or the identity of the manufacturer;
1088	1055
1089		-	SB1324 HFLR Page 22
1090		-	BOLD FACE denotes Committee Amendments. 1
	1056	+	ENGR. S. B. NO. 1324 Page 22 1
1091	1057		2
1092	1058		3
1093	1059		4
1094	1060		5
1095	1061		6
1096	1062		7
1097	1063		8
1098	1064		9
1099	1065		10
1100	1066		11
1101	1067		12
1102	1068		13
1103	1069		14
1104	1070		15
1105	1071		16
1106	1072		17
1107	1073		18
1108	1074		19
1109	1075		20
1110	1076		21
1111	1077		22
1112	1078		23
1113	1079		24
1114	1080
1115		-	about a specific drug or class of drugs, or a specific
1116		-	product or therapeutic class of products. Additional
1117		-	information that shall not be disclosed includes but
1118		-	is not limited to:
1119		-	(1) any information relating to specific drugs or
1120		-	classes of drugs that would disclose the identity
1121		-	of a specific health plan, d rug prices, the
1122		-	rebate amount received by a pharmacy benefits
1123		-	manager, the rebate amount received by the
1124		-	insurer, or the identity of the manufacturer, and
1125		-	(2) any information relating to a product or
1126		-	therapeutic class of products that would disclose
1127		-	the rebate received by a pharmacy benefits
1128		-	manager, the rebate amount received by an
1129		-	insurer, or the identity of the manufacturer;
1130	1081		2. "Public body" shall include, but not be limited to, any
1131	1082		office, department, board, bureau, commission, agency, trusteeship,
1132	1083		authority, council, committee, tr ust or any entity created by a
1133	1084		trust, county, city, village, town, township, district, school
1134	1085		district, fair board, court, execu tive office, advisory group, task
1135	1086		force, study group, or any subdivision thereof, supported in whole
1136	1087		or in part by public funds or entrusted with the expenditure of
1137	1088		public funds or administering or operating public property, and all
1138	1089		committees, or subcommi ttees thereof. Except for the records
	1090	+	required by Section 24 A.4 of this title, "public body" public body
	1091	+	does not mean judges, justices, th e Council on Judicial Complaints,
	1092	+	the Legislature, or legislators;
	1093	+	3. "Public office" means the physical location where public
	1094	+	bodies conduct business or keep records;
	1095	+	4. "Public official" means any official or employee of any
	1096	+	public body as defined here in; and
	1097	+	5. "Law enforcement agency" means any public body charged with
	1098	+	enforcing state or local criminal laws and initiating criminal
	1099	+	prosecutions, including, but not limited t o, police departments,
	1100	+	county sheriffs, the Department of Public Safety, the Ok lahoma State
	1101	+	Bureau of Narcotics and Dangerous Dru gs Control, the Alcoholic
	1102	+	Beverage Laws Enforcement Com mission, and the Oklahoma State Bureau
	1103	+	of Investigation.
1139	1104
1140		-	SB1324 HFLR Page 23
1141		-	BOLD FACE denotes Committee Amendments. 1
	1105	+	ENGR. S. B. NO. 1324 Page 23 1
1142	1106		2
1143	1107		3
1144	1108		4
1145	1109		5
1146	1110		6
1147	1111		7
1148	1112		8
1149	1113		9
1150	1114		10
1151	1115		11
1152	1116		12
1153	1117		13
1154	1118		14
1155	1119		15
1156	1120		16
1157	1121		17
1158	1122		18
1159	1123		19
1160	1124		20
1161	1125		21
1162	1126		22
1163	1127		23
1164	1128		24
1165	1129
1166		-	required by Section 24A.4 of this title, "public body" public body
1167		-	does not mean judges, justices, th e Council on Judicial Complaints,
1168		-	the Legislature, or legislators;
1169		-	3. "Public office" means the physical location where public
1170		-	bodies conduct business or keep re cords;
1171		-	4. "Public official" means any official or e mployee of any
1172		-	public body as defined here in; and
1173		-	5. "Law enforcement agency" means any public body charged with
1174		-	enforcing state or local criminal laws and initiating criminal
1175		-	prosecutions, including, but not limited to, police departments,
1176		-	county sheriffs, the Department of Public Safety, the Ok lahoma State
1177		-	Bureau of Narcotics and Dangerous Dru gs Control, the Alcoholic
1178		-	Beverage Laws Enforcement Com mission, and the Oklahoma State Bureau
1179		-	of Investigation.
1180	1130		SECTION 8. AMENDATORY 59 O.S. 2021, Section 357, is
1181	1131		amended to read as follows:
1182	1132		Section 357. As used in this act:
1183	1133		1. "Covered entity" means a nonprofit hospital or medical
1184	1134		service organization, insurer, health coverage plan or health
1185	1135		maintenance organization; a health program administered by the st ate
1186	1136		in the capacity of provider of health coverage; or an empl oyer,
1187	1137		labor union, or other entity organized in the state that provides
1188	1138		health coverage to covered individuals who are employed or reside in
1189	1139		the state. This term does not include a health plan that provides
	1140	+	coverage only for accidental injury, specified d isease, hospital
	1141	+	indemnity, disability income, or other limited benefit health
	1142	+	insurance policies and contracts th at do not include prescription
	1143	+	drug coverage;
	1144	+	2. "Covered individual" means a member, participant, enrollee,
	1145	+	contract holder or policy holder or beneficiary of a covered entity
	1146	+	who is provided health coverage by the covered ent ity. A covered
	1147	+	individual includes any dependent or other person provided health
	1148	+	coverage through a policy, contract or plan for a covered
	1149	+	individual;
	1150	+	3. "Department" means the Oklahoma Insurance Department;
	1151	+	4. "Maximum allowable cost " or "MAC" means the list of drug
	1152	+	products delineating the maximum per-unit reimbursement for
	1153	+	multiple-source prescription drug s, medical product or device;
1190	1154
1191		-	SB1324 HFLR Page 24
1192		-	BOLD FACE denotes Committee Amendments. 1
	1155	+	ENGR. S. B. NO. 1324 Page 24 1
1193	1156		2
1194	1157		3
1195	1158		4
1196	1159		5
1197	1160		6
1198	1161		7
1199	1162		8
1200	1163		9
1201	1164		10
1202	1165		11
1203	1166		12
1204	1167		13
1205	1168		14
1206	1169		15
1207	1170		16
1208	1171		17
1209	1172		18
1210	1173		19
1211	1174		20
1212	1175		21
1213	1176		22
1214	1177		23
1215	1178		24
1216	1179
1217		-	coverage only for accidental injury, specified d isease, hospital
1218		-	indemnity, disability income, or other limited benefit health
1219		-	insurance policies and contracts th at do not include prescription
1220		-	drug coverage;
1221		-	2. "Covered individual" means a member, participant, enrollee,
1222		-	contract holder or policy holder or beneficiary of a covered entity
1223		-	who is provided health coverage by the covered ent ity. A covered
1224		-	individual includes any dependent or other person provided health
1225		-	coverage through a policy, contract or plan for a covered
1226		-	individual;
1227		-	3. "Department" means the Oklahoma Insurance Department;
1228		-	4. "Maximum allowable cost " or "MAC" means the list of drug
1229		-	products delineating the maximum per-unit reimbursement for
1230		-	multiple-source prescription drugs, medical product or device;
1231	1180		5. "Multisource drug product re imbursement" (reimbursement)
1232	1181		means the total amount paid to a pharmacy inclusive of an y reduction
1233	1182		in payment to the pharmacy, excluding prescription dispense fees;
1234	1183		6. "Pharmacy benefits managem ent" means a service provided to
1235	1184		covered entities to facilitat e the provision of prescription drug
1236	1185		benefits to covered individuals within the state , including
1237	1186		negotiating pricing and other terms with drug manufacturers and
1238	1187		providers. Pharmacy benefits man agement may include any or all of
1239	1188		the following services:
	1189	+	a. claims processing, performance of drug utilization
	1190	+	review, processing of prior authorization requests,
	1191	+	retail network management and payment of claims to
	1192	+	pharmacies for prescription drugs dispens ed to covered
	1193	+	individuals,
	1194	+	b. clinical formulary development a nd management
	1195	+	services,
	1196	+	c. rebate contracting and administration,
	1197	+	d. certain patient compliance, therapeutic inter vention
	1198	+	and generic substitution programs, or
	1199	+	e. disease management programs,
	1200	+	f. adjudication of appeals and gri evances related to the
	1201	+	prescription drug benefit, and
	1202	+	g. oversight of prescription drug costs;
1240	1203
1241		-	SB1324 HFLR Page 25
1242		-	BOLD FACE denotes Committee Amendments. 1
	1204	+	ENGR. S. B. NO. 1324 Page 25 1
1243	1205		2
1244	1206		3
1245	1207		4
1246	1208		5
1247	1209		6
1248	1210		7
1249	1211		8
1250	1212		9
1251	1213		10
1252	1214		11
1253	1215		12
1254	1216		13
1255	1217		14
1256	1218		15
1257	1219		16
1258	1220		17
1259	1221		18
1260	1222		19
1261	1223		20
1262	1224		21
1263	1225		22
1264	1226		23
1265	1227		24
1266	1228
1267		-	a. claims processing, performance of drug utilization
1268		-	review, processing of prior authorization requests,
1269		-	retail network management and payment of claims to
1270		-	pharmacies for prescription drugs dispensed to covered
1271		-	individuals,
1272		-	b. clinical formulary development a nd management
1273		-	services,
1274		-	c. rebate contracting and administration,
1275		-	d. certain patient compliance, therapeutic inter vention
1276		-	and generic substitution programs, or
1277		-	e. disease management programs,
1278		-	f. adjudication of appeals and gri evances related to the
1279		-	prescription drug benefit, and
1280		-	g. oversight of prescription drug costs;
1281	1229		7. "Pharmacy benefits manager" or "PBM" means a person,
1282	1230		business or other entity that, either directly or through an
1283	1231		intermediary, performs pharmacy benefit s management. The term
1284	1232		includes a person or entity acting for a PBM in a contractual or
1285	1233		employment relationship in the performance of pharmacy benefits
1286	1234		management for a managed care company, nonprofit hospital, medical
1287	1235		service organization, insurance comp any, third-party payor, or a
1288	1236		health program administered by an agency of this state;
1289	1237		8. "Plan sponsor" means the employers, insurance companies,
1290	1238		unions and health maintenance organizations or any other entity
	1239	+	responsible for establishing, maintaining, or administering a health
	1240	+	benefit plan on behalf of covered individuals; and
	1241	+	9. "Provider" means a pharmacy licensed by th e State Board of
	1242	+	Pharmacy, or an agent or representative of a pharmacy, including,
	1243	+	but not limited to, t he pharmacy's contracting agent, which
	1244	+	dispenses prescription drugs or devices to covered individuals.
	1245	+	SECTION 9. AMENDATORY 59 O.S. 2021, Section 358, is
	1246	+	amended to read as follows:
	1247	+	Section 358. A. In order to provide pharmacy benefits
	1248	+	management or any of the service s included under the definition of
	1249	+	pharmacy benefits management in this state, a pharmacy benefits
	1250	+	manager or any entity acting as one in a contractual or employment
	1251	+	relationship for a covered entity shall first obtain a license from
1291	1252
1292		-	SB1324 HFLR Page 26
1293		-	BOLD FACE denotes Committee Amendments. 1
	1253	+	ENGR. S. B. NO. 1324 Page 26 1
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1317	1277
1318		-	responsible for establishing, maintaining, or administering a health
1319		-	benefit plan on behalf of covered individuals; and
1320		-	9. "Provider" means a pharmacy licensed by th e State Board of
1321		-	Pharmacy, or an agent or representative of a pharmacy, including,
1322		-	but not limited to, the pharmacy's contracting agent, which
1323		-	dispenses prescription drugs or devices to covered individuals.
1324		-	SECTION 9. AMENDATORY 59 O.S. 2021, Section 358, is
1325		-	amended to read as follows:
1326		-	Section 358. A. In order to provide pharmacy benefits
1327		-	management or any of the service s included under the definition of
1328		-	pharmacy benefits management in this state, a pharmacy benefits
1329		-	manager or any entity acting as one in a contractual or employment
1330		-	relationship for a covered entity shall first obtain a license from
1331	1278		the Oklahoma Insurance Department, and the Department may charge a
1332	1279		fee for such licensure.
1333	1280		B. The Department shall establish, by regulation, licensure
1334	1281		procedures, required disclosures for pharmacy benefits managers
1335	1282		(PBMs) and other rules as may be necessary for carrying out an d
1336	1283		enforcing the provisions of this act section. The licensure
1337	1284		procedures shall, at a minimum, include the completion of an
1338	1285		application form that shall include the name and address of an agent
1339	1286		for service of process, the payment of a requisite fee, and evidence
1340	1287		of the procurement of a surety bond:
1341	1288		1. The name, address, and telephone contact number of the PBM ;
	1289	+	2. The name and address of the PBM's agent for service of
	1290	+	process in the state;
	1291	+	3. The name and address of each person with management or
	1292	+	control over the PBM;
	1293	+	4. Evidence of the procurement of a su rety bond;
	1294	+	5. The name and address of each person with a ben eficial
	1295	+	ownership interest in the PBM;
	1296	+	6. In the case of a PBM applicant that is a partnership or
	1297	+	other unincorporated association, limited liability company, or
	1298	+	corporation, and has five or more partners, members, or
	1299	+	stockholders, the applicant shall:
	1300	+	a. specify its legal structure and the total number of
	1301	+	its partners, members, or stockholders,
1342	1302
1343		-	SB1324 HFLR Page 27
1344		-	BOLD FACE denotes Committee Amendments. 1
	1303	+	ENGR. S. B. NO. 1324 Page 27 1
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1368	1327
1369		-	2. The name and address of the PBM's agent for service of
1370		-	process in the state;
1371		-	3. The name and address of each person with management or
1372		-	control over the PBM;
1373		-	4. Evidence of the procurement of a su rety bond;
1374		-	5. The name and address of each person with a ben eficial
1375		-	ownership interest in the PBM;
1376		-	6. In the case of a PBM applicant that is a partnership or
1377		-	other unincorporated association, limited liability company, or
1378		-	corporation, and has five or more partners, members, or
1379		-	stockholders, the applicant shall:
1380		-	a. specify its legal structure and the total number of
1381		-	its partners, members, or stockholders,
1382	1328		b. specify the name, address, usual occupation, and
1383	1329		professional qualifications of the five partners,
1384	1330		members, or stockholders with the five largest
1385	1331		ownership interests in the PBM, and
1386	1332		c. upon request by the Department, furnish the Department
1387	1333		with information regardi ng the name, address, usual
1388	1334		occupation, and professional qualification s of any
1389	1335		other partners, members, or stockholders; and
1390	1336		7. A signed statement in dicating that the PBM has not been
1391	1337		convicted of a felony and has not violated any of the requirements
1392	1338		of the Oklahoma Pharmacy Act and the Patient 's Right to Pharmacy
	1339	+	Choice Act, or, if the applicant cannot provide such a statement, a
	1340	+	signed statement descr ibing any relevant conviction or violation.
	1341	+	C. The Department may subpoena witnesses and information. Its
	1342	+	compliance officers may take and copy records for investigative use
	1343	+	and prosecutions. Nothing in this subsection shall limit the Office
	1344	+	of the Attorney General from using its investigative demand
	1345	+	authority to investigate and prosecute violations of the law.
	1346	+	D. The Department may suspend, revoke, or refuse to issue or
	1347	+	renew a license for nonc ompliance with any of the provisions hereby
	1348	+	established or with the rules promulgated by the Department; for
	1349	+	conduct likely to mislead, deceive or defraud the public or the
	1350	+	Department; for unfair or deceptive business practices or for
	1351	+	nonpayment of a renew al fee or fine. The Department may also levy
1393	1352
1394		-	SB1324 HFLR Page 28
1395		-	BOLD FACE denotes Committee Amendments. 1
	1353	+	ENGR. S. B. NO. 1324 Page 28 1
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1419	1377
1420		-	Choice Act, or, if the applicant cannot provide such a statement, a
1421		-	signed statement descr ibing any relevant conviction or violation.
1422		-	C. The Department may subpoena witnesses and information. Its
1423		-	compliance officers may take and copy records for investigative use
1424		-	and prosecutions. Nothing in this subsection shall limit the Office
1425		-	of the Attorney General from using its investigative demand
1426		-	authority to investigate and prosecute violations of the law.
1427		-	D. The Department may suspend, revoke, or refuse to issue or
1428		-	renew a license for non compliance with any of the provisions hereby
1429		-	established or with the rules promulgated by the Department; for
1430		-	conduct likely to mislead, deceive or defraud the public or the
1431		-	Department; for unfair or deceptive business practices or for
1432		-	nonpayment of a rene wal fee or fine. The Department may also levy
1433	1378		administrative fines for each count of which a PBM has been
1434	1379		convicted in a Department hearing.
1435	1380		SECTION 10. This act shall become effective November 1, 2022.
	1381	+	Passed the Senate the 23rd day of March, 2022.
1436	1382
1437		-	COMMITTEE REPORT BY: COMMITTEE ON PUBLIC HEALTH, dated 04/06/2022 -
1438		-	DO PASS, As Amended and Coauthored.
	1383	+
	1384	+
	1385	+	Presiding Officer of the Senate
	1386	+
	1387	+
	1388	+	Passed the House of Representatives the ____ day of __________,
	1389	+	2022.
	1390	+
	1391	+
	1392	+
	1393	+	Presiding Officer of the House
	1394	+	of Representatives
	1395	+