Oklahoma 2022 Regular Session

Oklahoma Senate Bill SB721 Compare Versions

Version 1 (Old)

Version 2 (New)

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3		-	SB721 HFLR Page 1
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	3	+	ENGR. S. B. NO. 721 Page 1 1
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29		-	HOUSE OF REPRESENTATIVES - FLOOR VERSION
30		-
31		-	STATE OF OKLAHOMA
32		-
33		-	1st Session of the 58th Legislature (2021)
34	27
35	28		ENGROSSED SENATE
36	29		BILL NO. 721 By: Hicks and Simpson of the
37	30		Senate
38	31
39	32		and
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41	34		McEntire of the House
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47	40		An Act relating to prescription drugs; creating the
48	41		Access to Lifesaving Medicines Act; defining terms;
49	42		prohibiting insurers and pharmacy benef it managers
50	43		from imposing certain cost to an insured; requiring
51	44		health benefit manager to offer certain discount to
52	45		certain entities; specifying certain prescription
53	46		drug cost maximums; authorizing Commissioner to
54	47		promulgate rules; providing for noncodific ation;
55	48		providing for codification; and providing an
56	49		effective date.
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61	54		BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
62	55		SECTION 1. NEW LAW A new section of law not to be
63	56		codified in the Oklahoma Statutes reads as follo ws:
64	57		This act shall be known and may be cited as the “Access to
65	58		Lifesaving Medicines Act ”.
66	59		SECTION 2. NEW LAW A new secti on of law to be codified
67	60		in the Oklahoma Statutes as Section 6970 of Title 36, unless there
68	61		is created a duplica tion in numbering, reads as follows:
	62	+	As used in this act:
	63	+	1. “Adjusted out-of-pocket amount” means the co-payment, co-
	64	+	insurance or other cost sharing obligation the health benefit plan
69	65
70		-	SB721 HFLR Page 2
71		-	BOLD FACE denotes Committee Amendments. 1
	66	+	ENGR. S. B. NO. 721 Page 2 1
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96		-	As used in this act:
97		-	1. “Adjusted out-of-pocket amount” means the co-payment, co-
98		-	insurance or other cost sharing obligation the health benefit plan
99	91		requires the insured to pay at th e point of sale for a covered
100	92		prescription medication otherwise payable, less the pro rata portion
101	93		of any discounts, rebates and price concessions in connection with
102	94		the prescription drug;
103	95		2. “Claim” means any bill, claim or proof of loss made by or on
104	96		behalf of an insured or a provider to a health insurer or its
105	97		intermediary, administra tor or representative , with which the
106	98		provider has a provider contract for payment for health care
107	99		services under any health benefit plan;
108	100		3. “Commissioner” means the Insurance Commissioner ;
109	101		4. “Excess cost burden” means any co-payments, co-insurance or
110	102		other cost sharing an insured is required to pay at th e point-of-
111	103		sale to receive a prescripti on drug or device, that exceeds the
112	104		health insurer’s or pharmacy benefit manager’s net cost after
113	105		applying a pro-rata portion of any discounts, rebates or concessions
114	106		received from manufacturers, pharmacies or other t hird parties;
115	107		5. “Health benefit plan” means any individual or group health
116	108		benefit plan, subscription contract, evidence of coverage,
117	109		certificate, health services plan, medical or hospital services
118	110		plan, accident and sickness insurance policy or certific ate, managed
119	111		care health insurance plan or other similar certificate, policy,
	112	+	contract or arrangement, an d any endorsement or rider thereto, to
	113	+	cover all or a portion of the cost of persons receiving covered
	114	+	health care services, which is subject to state regulation and which
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121		-	SB721 HFLR Page 3
122		-	BOLD FACE denotes Committee Amendments. 1
	116	+	ENGR. S. B. NO. 721 Page 3 1
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147		-	contract or arrangement, and any endorsement or rider thereto, to
148		-	cover all or a portion of the cost of persons receiving covered
149		-	health care services, which is subject to state regulation and which
150	141		is required to be offered, arranged or issued in this state. Health
151	142		benefit plan shall not mean:
152	143		a. coverage issued pursuant to Title XVIII of the Social
153	144		Security Act, 42 U.S.C. § 75 1395 et seq. , as amended,
154	145		Title XIX of the Social S ecurity Act, 42 U.S.C. § 1396
155	146		et seq., as amended, or Title XXI of the Social
156	147		Security Act, 42 U.S.C. § 1397aa et seq., as amended,
157	148		5 U.S.C. § 8901 et seq. , as amended, or 10 U.S.C. §
158	149		1071 et seq., as amended or,
159	150		b. accident only, credit or disability insu rance, long-
160	151		term care insurance, TRICAR E supplement, Medicare
161	152		supplement, or workers ’ compensation coverages;
162	153		6. “Health care provider ” or “provider” means a person who is
163	154		licensed, certified or otherwise authorized by the laws of this
164	155		state as a physician, physician assistant, certified nurse
165	156		practitioner, advanced practice registered nurse , to include one
166	157		with a certified specialty , registered nurse or licensed practical
167	158		nurse, but shall not include a nurse midwif e;
168	159		7. “Health insurer” means any entity subject to the
169	160		jurisdiction of the Insurance Department and the insurance laws and
170	161		regulations of this state that contracts or offers to contract to
	162	+	provide, deliver, arrange for, pay for or reimburse any of the costs
	163	+	of health care services including but not limited to a health
	164	+	maintenance organization, a health benefit plan or any other entity
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172		-	SB721 HFLR Page 4
173		-	BOLD FACE denotes Committee Amendments. 1
	166	+	ENGR. S. B. NO. 721 Page 4 1
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198		-	provide, deliver, arrange for, pay for or reimburse any of the costs
199		-	of health care services including but not limited to a health
200		-	maintenance organization, a health benefit plan or any other entity
201	191		providing a plan of health insurance, health benefits or health care
202	192		services;
203	193		8. “Insured” means a consumer covered under a health benefit
204	194		plan with prescription drug coverage that is offered by a health
205	195		insurer;
206	196		9. “Maximum allowable claim ” means the amount the health
207	197		insurer or pharmacy benefits manager has agreed to pay a pharmacy,
208	198		as defined in Section 353.1 of Title 59 of the Oklahoma Statutes ,
209	199		for the prescription medication;
210	200		10. “Maximum allowable cost” means the maximum dollar amount
211	201		that a health insurer or its intermediary will reimburse a pharmacy
212	202		provider for a group of drugs rated as “A”, “AB”, “NR” or “NA” in
213	203		the most recent edition of the Approved D rug Products with
214	204		Therapeutic Equivalen ce Evaluations, published by the U.S. Food and
215	205		Drug Administration, or simila rly rated by a nationally recognized
216	206		reference;
217	207		11. “Point of sale” means the transaction in which goods or
218	208		services, which shall include but are not limited to prescription
219	209		medications, medical devices and supplies, are sold to the consumer;
220	210		12. “Rebate” includes but is not limited to the following:
	211	+	a. negotiated price concessions including but not limited
	212	+	to base rebates and reasonable est imates of any price
	213	+	protection rebates and performance-based rebates that
	214	+	may accrue directly or indirectly to the health
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222		-	SB721 HFLR Page 5
223		-	BOLD FACE denotes Committee Amendments. 1
	216	+	ENGR. S. B. NO. 721 Page 5 1
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248		-	a. negotiated price concessions including but not limited
249		-	to base rebates and reasonable estimates of any price
250		-	protection rebates and performance -based rebates that
251		-	may accrue directly or indirectly to the health
252	241		insurer or pharmacy benefit mana ger as a result of
253	242		point of sale prescription medication claims
254	243		processing during the coverage year fr om a
255	244		manufacturer, dispensing pharmac y or other party to
256	245		the transaction, or
257	246		b. reasonable estimates of any fees and other
258	247		administrative costs that are p assed through to the
259	248		health insurer as a result of point of sale
260	249		prescription medication claims proces sing and serve to
261	250		reduce the health insurer’s prescription medication
262	251		liabilities for the coverage year; and
263	252		13. “Provider contract” means any contract between a provider
264	253		and a health insurer, or an insurer’s network, provider pan el,
265	254		intermediary or repre sentative, relating to the provision of h ealth
266	255		care services.
267	256		SECTION 3. NEW LAW A new section of law to be codified
268	257		in the Oklahoma Statutes as Section 6971 of Title 36, unless there
269	258		is created a duplication in numbering, reads as follows:
270	259		A. Health insurers and pharmacy benefit managers that issue,
271	260		renew, or amend health benefit plans with prescription drug coverage
	261	+	in this state are prohibited from imposing excess cost burden on an
	262	+	insured.
	263	+	B. When contracting with a health insurer or health benefit
	264	+	plan to administer pharmacy benefits, a pharmacy benefits manager
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273		-	SB721 HFLR Page 6
274		-	BOLD FACE denotes Committee Amendments. 1
	266	+	ENGR. S. B. NO. 721 Page 6 1
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299		-	in this state are prohibited from imposing excess cost burden on an
300		-	insured.
301		-	B. When contracting with a health insurer or health benefit
302		-	plan to administer pharmacy benefits, a pharm acy benefits manager
303	291		shall offer the carrier or health plan the option of extending
304	292		point-of-sale rebates to enrollees of the plan .
305	293		C. Prescription drug cost sharing for an insured shall be the
306	294		lesser of:
307	295		1. The applicable co-payment for the prescription medication
308	296		that would be payable in the absence of this section;
309	297		2. The maximum allowable cost;
310	298		3. The maximum allowable claim;
311	299		4. The adjusted out -of-pocket amount as determined pursua nt to
312	300		Section 2 of this act;
313	301		5. The amount an insured would pay for the prescription
314	302		medication if they purchased it without usin g their health benefit
315	303		plan or any other source of prescription medication benefits or
316	304		discounts; or
317	305		6. The amount the pharma cy will be reimbursed for the
318	306		prescription medication by the health insurer or pharmacy benefit
319	307		manager.
320	308		D. The Insurance Commiss ioner shall promulgate rules and
321	309		regulations to implement the provisions of this section.
	310	+	SECTION 4. This act shall become effectiv e November 1, 2021.
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323		-	SB721 HFLR Page 7
324		-	BOLD FACE denotes Committee Amendments. 1
	312	+	ENGR. S. B. NO. 721 Page 7 1
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349		-	~~SECTION 4.~~ ~~This act shall become effective November 1~~, 2021.
	337	+	Passed the Senate the 11th day of March, 2021.
350	338
351		-	COMMITTEE REPORT BY: CO MMITTEE ON PUBLIC HEALTH, dated 04/07/2021 -
352		-	DO PASS.
	339	+
	340	+
	341	+	Presiding Officer of the Senate
	342	+
	343	+
	344	+	Passed the House of Represe ntatives the ____ day of __________,
	345	+	2021.
	346	+
	347	+
	348	+
	349	+	Presiding Officer of the House
	350	+	of Representatives
	351	+