Oklahoma 2022 Regular Session

Oklahoma Senate Bill SB1635 Compare Versions

Version 1 (Old)

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3		-	SB1635 HFLR Page 1
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	3	+	ENGR. S. B. NO. 1635 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	28		ENGROSSED SENATE
36	29		BILL NO. 1635 By: Jett and Stephens of the
37	30		Senate
38	31
39	32		and
40	33
41	34		McEntire of the House
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44	35
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47	38		An Act relating to pharmacy benefits managers;
48	39		amending 36 O.S. 2021, Sections 6960 and 6962, which
49	40		relate to definitions and compliance review;
50	41		modifying definitions; prohibiting certain actions by
51	42		pharmacy benefits managers; providing enforcement
52	43		measures for certain violations of the Patient ’s
53	44		Right to Pharmacy Choice Act; directing deposit of
54	45		certain attorney fees; updating statutory language;
55	46		providing for codification; and providing an
56	47		effective date.
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61	52		BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
62	53		SECTION 1. AMENDATORY 36 O.S. 2021, Section 6960, is
63	54		amended to read as follows:
64	55		Section 6960. For purposes of the Patient’s Right to Pharmacy
65	56		Choice Act:
66	57		1. “Clawback” means an act by the pharmacy benefits manager
67	58		(PBM) of recovering from the dispensing pharmac y and keeping as
68	59		revenue the difference between a patient’s co-payment and the
	60	+	pharmacy drug cost when the co-payment exceeds the pharmacy drug
	61	+	cost;
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70		-	SB1635 HFLR Page 2
71		-	BOLD FACE denotes Committee Amendments. 1
	63	+	ENGR. S. B. NO. 1635 Page 2 1
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96		-	pharmacy drug cost when the co-payment exceeds the pharmacy drug
97		-	cost;
98	88		1. 2. “Health insurer” means any corporation, association,
99	89		benefit society, exchange, partnership or individual licensed by the
100	90		Oklahoma Insurance Code;
101	91		2. 3. “Mail-order pharmacy” means a pharmacy licensed by this
102	92		state that primarily dispen ses and delivers covered drugs via common
103	93		carrier;
104	94		3. 4. “Pharmacy benefits manager ” or “PBM” means a person that
105	95		performs pharmacy benefits management and any other person acting
106	96		for such person under a contractu al or employment relationship in
107	97		the performance of pharmacy benefits management for a mana ged-care
108	98		company, nonprofit hospital, medical service organization, insuranc e
109	99		company, third-party payor or a health program administered by a
110	100		department of this sta te;
111	101		4. 5. “Pharmacy and therapeutics commit tee” or “P&T committee”
112	102		means a committee at a h ospital or a health insurance plan that
113	103		decides which drugs will appear on that entity’s drug formulary;
114	104		5. 6. “Retail pharmacy network” means retail pharmacy providers
115	105		contracted with a PBM in which the phar macy primarily fills and
116	106		sells prescriptions via a retail, storefront location;
117	107		6. 7. “Rural service area” means a five-digit ZIP code in which
118	108		the population density is less than one thousand (1,000) individuals
119	109		per square mile;
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121		-	SB1635 HFLR Page 3
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147	136		7. 8. “Suburban service area” means a five-digit ZIP code in
148	137		which the population density is between one thousand (1,000) and
149	138		three thousand (3,00 0) individuals per square mile; and
150	139		8. 9. “Urban service area” means a five-digit ZIP code in which
151	140		the population density is greater th an three thousand (3,000)
152	141		individuals per square mile.
153	142		SECTION 2. AMENDATORY 36 O.S. 2021, Section 6962, is
154	143		amended to read as follows:
155	144		Section 6962. A. The Oklahoma Insurance Depart ment shall
156	145		review and approve retail pharmacy network access for all pharmacy
157	146		benefits managers (PBMs) to ensure compliance with Section 4 of this
158	147		act Section 6961 et seq. of this title.
159	148		B. A PBM, or an agent of a PBM, shall not:
160	149		1. Cause or knowingly pe rmit the use of advertisement,
161	150		promotion, solicitation, representation, proposal or offer that is
162	151		untrue, deceptive or misleading;
163	152		2. Charge a pharmacist or pharmacy a fee related to the
164	153		adjudication or submission of a claim, including without limitation
165	154		a fee for:
166	155		a. the submission of a claim,
167	156		b. enrollment or particip ation in a retail pharmacy
168	157		network, or
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170		-	SB1635 HFLR Page 4
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196	184		c. the development or management of claims processing
197	185		services or claims payment service s related to
198	186		participation in a retail pharmacy network;
199	187		3. Charge a pharmacist or pharmacy a fee related to the
200	188		credentialing of a p harmacy or pharmacist;
201	189		4. Charge a pharmacist or pharmacy a fee related to the
202	190		application, enrollment, or participation in a retail pharmacy
203	191		network;
204	192		5. Charge a pharmacist or pharma cy a fee related to the
205	193		development or management of claims processing s ervices or claims
206	194		payment services related to participation in a retail pharmacy
207	195		network;
208	196		6. Reimburse a pharmacy or pharmacist in the state an amount
209	197		less than the amount that the PBM reimburses a pharmacy owned by or
210	198		under common ownership with a PBM for providing the same covered
211	199		services. The reimbursement amount paid to the phar macy shall be
212	200		equal to the reimbursement amount calculated on a per-unit basis
213	201		using the same generic product identifier or generic code number
214	202		paid to the PBM-owned or PBM-affiliated pharmacy;
215	203		4. 7. Deny a pharmacy the opportunity to participate in any
216	204		pharmacy network at preferred participation status if the pharmacy
217	205		is willing to accept the terms and conditions that the PBM has
218	206		established for other pharmacies as a condition of preferred network
219	207		participation status;
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221		-	SB1635 HFLR Page 5
222		-	BOLD FACE denotes Committee Amendments. 1
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247	234		5. 8. Deny, limit or terminate a pharmacy ’s contract based on
248	235		employment status of any employee who has an active license to
249	236		dispense, despite probation status, with the State Bo ard of
250	237		Pharmacy;
251	238		6. 9. Retroactively deny or reduce reimbursement for a covered
252	239		service claim after returning a paid clai m response as part of the
253	240		adjudication of the claim, unless:
254	241		a. the original claim was submitted fraudulently, or
255	242		b. to correct errors id entified in an audit, so long as
256	243		the audit was conducted in compliance with Sections
257	244		356.2 and 356.3 of Title 59 of the Oklahoma Statutes;
258	245		or
259	246		7. 10. Fail to make any payment due to a pharmacy or pharmaci st
260	247		for covered services properly rendered in the event a PBM terminates
261	248		a pharmacy or pharmacist from a pharmacy benefits manager network ;
262	249		or
263	250		11. Participate in a clawback as defined in Section 1 of this
264	251		act.
265	252		C. The prohibitions under this section shall apply to contracts
266	253		between pharmacy benefits managers and pharmacists or pharmacies for
267	254		participation in retail pharmacy networks.
268	255		1. A PBM contract shall:
269	256		a. not restrict, directly or indirectly, any pha rmacy
270	257		that dispenses a prescription drug from informing, or
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272		-	SB1635 HFLR Page 6
273		-	BOLD FACE denotes Committee Amendments. 1
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298	284		penalize such pharmacy for informing, an individual of
299	285		any differential between the ind ividual’s out-of-
300	286		pocket cost or coverage with re spect to acquisition of
301	287		the drug and the amount an individual would pay to
302	288		purchase the drug directly, and
303	289		b. ensure that any entity that provides pharmacy benefits
304	290		management services under a contract with a ny such
305	291		health plan or health insurance coverage does not,
306	292		with respect to such plan or coverage, restrict,
307	293		directly or indirectly, a pharmacy that dispenses a
308	294		prescription drug from informing, or penalize such
309	295		pharmacy for informing, a covered individual of any
310	296		differential between the individual’s out-of-pocket
311	297		cost under the plan or coverage with respect to
312	298		acquisition of the drug and the amount an individual
313	299		would pay for acquisition of the drug without using
314	300		any health plan or health insurance coverage , and
315	301		c. ensure that access to local healthca re is not
316	302		jeopardized by immediately modifying any rates or
317	303		provisions that would result in a reimbursement below
318	304		the pharmacy’s cost to acquire and dispense the
319	305		medication or product .
320	306		2. A pharmacy benefits manager’s contract with a participating
321	307		pharmacist or pharmacy shall not prohibit, restrict or limit
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323		-	SB1635 HFLR Page 7
324		-	BOLD FACE denotes Committee Amendments. 1
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349	334		disclosure of information to the Insurance Commissioner, law
350	335		enforcement or state and federal governmental officials
351	336		investigating or examining a complaint or conducting a revie w of a
352	337		pharmacy benefits manager’s compliance with the requir ements under
353	338		the Patient’s Right to Pharmacy Choice Act.
354	339		3. A pharmacy benefits manager shall establish and maintain an
355	340		electronic claim inquiry p rocessing system using the National
356	341		Council for Prescription Drug Programs’ current standards to
357	342		communicate information to pharmacies submit ting claim inquiries.
358	343		SECTION 3. NEW LAW A new section of law to be codified
359	344		in the Oklahoma Statutes as Section 6966.1 of Title 36, unless there
360	345		is created a duplication in numbering, reads as follows:
361	346		A. Notwithstanding any other provisions of law, the Insurance
362	347		Commissioner, upon finding a pharmacy benefits manager in violat ion
363	348		of Section 6962 of Title 36 of the Oklahoma Statu tes, shall issue a
364	349		cease and desist order to the PBM directing it to stop the unlawful
365	350		practice. If the PBM fails or refuses to comply with the order, the
366	351		Commissioner shall have the authority to revoke or suspend the PBM’s
367	352		license. The Commissioner shall use his or her authority to the
368	353		extent necessary to obtain the PBM’s compliance with the order. If
369	354		requested by the Commissioner, the Att orney General shall offer his
370	355		or her assistance to enforce the order of the Commissioner.
371	356		B. Reasonable attorney fees shall be awarded the Commissioner
372	357		if judicial action is necessary for the enforcement of the order.
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374		-	SB1635 HFLR Page 8
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400	384		Fees collected by the Commissioner without assistance of the Office
401	385		of the Attorney General shall be credited to the Insurance
402	386		Commissioner’s Revolving Fund. Fees collected by the Attorney
403	387		General shall be credited to the Attorney Gene ral’s Revolving Fund.
404	388		SECTION 4. This act shall become effective November 1, 2022.
	389	+	Passed the Senate the 22nd day of March, 2022.
405	390
406		-	COMMITTEE REPORT BY: COMMITTEE ON PUBLIC HEALTH, dated 04/13/2022 -
407		-	DO PASS.
	391	+
	392	+
	393	+	Presiding Officer of the Senate
	394	+
	395	+
	396	+	Passed the House of Representatives the ____ day of __________,
	397	+	2022.
	398	+
	399	+
	400	+
	401	+	Presiding Officer of the House
	402	+	of Representatives
	403	+