Req. No. 465 Page 1 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
STATE OF OKLAHOMA
1st Session of the 58th Legislature (2021)
SENATE BILL 468 By: Hicks
AS INTRODUCED
An Act relating to health insurance; prohibiting a
health insurer from modifying covera ge of
prescription drug in certain circumstance; construing
clause; providing for certain civ il penalty;
providing for codification; and providing an
effective date.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new section of law to be codif ied
in the Oklahoma Statutes as Section 6850.2 of Title 36, unless there
is created a duplication in numb ering, reads as follows:
A. An insurer, as defined in Section 6 054 of Title 36 of the
Oklahoma Statutes, shall not modify an insured’s coverage of a
prescription drug, as defined in Section 367.2 of T itle 59 of the
Oklahoma Statutes, if the following conditions are met :
1. The prescription drug had been previously preauthorized for
coverage by the insu rer or was listed on the formulary of the
insurer at the time the insured was prescribed the drug by his or
her practitioner, as defined in Section 6054 of Title 36 of the
Oklahoma Statutes;
Req. No. 465 Page 2 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
2. The insured has already received the prescription drug ; and
3. A practitioner continues to prescribe the drug to the
insured.
Modification prohibited pursuant to this section shall include,
but is not limited to, raising the premium, copayment, coi nsurance
or deductible, denying or otherwise failing to provide cont inued
coverage of the prescription drug, moving the drug to a more
restrictive coverage category or tier, or replacing a brand -name
drug for a generic drug after the insured has qualified for the
brand-name drug pursuant to this section.
B. Nothing in this section shall be construed to prohibit a n
insurer from modifying coverage of a prescription drug if:
1. The federal Food and Drug Ad ministration has issued a
statement calling into question the clinical safety of the drug; or
2. The manufacturer of the drug has notified the federal Food
and Drug Administration of a manufacturing discontinuance or
potential discontinuance of the drug a s required by 21 U.S.C. 356c.
C. Any insurer that violates the provisions of this section
shall be subject to a civil penalty in an amount to be determined by
the Insurance Commissioner.
SECTION 2. This act shall become effective November 1, 2021.
58-1-465 CB 1/19/2021 12:48:48 PM