SB721 HFLR Page 1
BOLD FACE denotes Committee Amendments. 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
HOUSE OF REPRESENTATIVES - FLOOR VERSION
STATE OF OKLAHOMA
1st Session of the 58th Legislature (2021)
ENGROSSED SENATE
BILL NO. 721 By: Hicks and Simpson of the
Senate
and
McEntire of the House
An Act relating to prescription drugs; creating the
Access to Lifesaving Medicines Act; defining terms;
prohibiting insurers and pharmacy benefit managers
from imposing certain cost to an insured; requiring
health benefit manager to offer certain discount to
certain entities; specifying certain prescri ption
drug cost maximums; authorizing Commissioner to
promulgate rules; providing for noncodification;
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 not to be
codified in the Oklahoma Statutes reads as follows:
This act shall be known and may be cited as the “Access to
Lifesaving Medicines Act ”.
SECTION 2. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 6970 of Title 36, unless there
is created a duplication in numbering, reads as follows:
SB721 HFLR Page 2
BOLD FACE denotes Committee Amendments. 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
As used in this act:
1. “Adjusted out-of-pocket amount” means the co-payment, co-
insurance or other cost sharing obligation the health benefit plan
requires the insured to pay at the point of sale for a covered
prescription medication otherwise payable, less the pro rata portion
of any discounts, rebates and price concessions in connection with
the prescription drug;
2. “Claim” means any bill, claim or proof of loss made by or on
behalf of an insured or a provider to a health insurer or its
intermediary, administrator or representative , with which the
provider has a provider contract for payment for health care
services under any health benefit plan;
3. “Commissioner” means the Insurance Commissioner;
4. “Excess cost burden” means any co-payments, co-insurance or
other cost sharing an insured is required to pay at the point -of-
sale to receive a prescription drug or device, that exce eds the
health insurer’s or pharmacy benefit manager ’s net cost after
applying a pro-rata portion of any discounts, rebates or concessions
received from manufacturers, pharmacies or other third parties;
5. “Health benefit plan” means any individual or gro up health
benefit plan, subscription contract, evidence of coverage,
certificate, health services plan, medical or hospital services
plan, accident and sickness insurance policy or certificate, managed
care health insurance plan or other similar certificat e, policy,
SB721 HFLR Page 3
BOLD FACE denotes Committee Amendments. 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
contract or arrangement, and any endorsement or rider thereto, to
cover all or a portion of the cost of persons receiving covered
health care services, which is subject to state regulation and which
is required to be offered, arranged or issued in this state. Health
benefit plan shall not mean:
a. coverage issued pursuant to Title XVIII of the Social
Security Act, 42 U.S.C. § 75 1395 et seq. , as amended,
Title XIX of the Social Security Act, 42 U.S.C. § 1396
et seq., as amended, or Title XXI of the Social
Security Act, 42 U.S.C. § 1397aa et seq. , as amended,
5 U.S.C. § 8901 et seq. , as amended, or 10 U.S.C. §
1071 et seq., as amended or,
b. accident only, credit or disability insurance, long -
term care insurance, TRICARE supplement, Medicare
supplement, or workers’ compensation coverages;
6. “Health care provider ” or “provider” means a person who is
licensed, certified or otherwise authorized by the laws of this
state as a physician, physician assistant, certified nurse
practitioner, advanced prac tice registered nurse, to include one
with a certified specialty, registered nurse or licensed practical
nurse, but shall not include a nurse midwife ;
7. “Health insurer” means any entity subject to the
jurisdiction of the Insurance Department and the insurance laws and
regulations of this state that contracts or offers to contract to
SB721 HFLR Page 4
BOLD FACE denotes Committee Amendments. 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
provide, deliver, arrange for, pay for or reimburse any of the costs
of health care services including but not limited to a health
maintenance organization, a health benefit plan or any other entity
providing a plan of health insurance, health benefits or health care
services;
8. “Insured” means a consumer covered under a health benefit
plan with prescription drug coverage that is offered by a health
insurer;
9. “Maximum allowable claim” means the amount the health
insurer or pharmacy benefits manager has agreed to pay a pharmacy,
as defined in Section 353.1 of Title 59 of the Oklahoma Statutes,
for the prescription medication;
10. “Maximum allowable cost ” means the maximum dollar amount
that a health insurer or its intermediary will reimburse a pharmacy
provider for a group of drugs rated as “A”, “AB”, “NR” or “NA” in
the most recent edition of the Approved Drug Products with
Therapeutic Equivalence Evaluations, published by the U.S. Food and
Drug Administration, or similarly rated by a nationally recognized
reference;
11. “Point of sale” means the transaction in which goods or
services, which shall include but are not limited to prescription
medications, medical devices and supplies, are sold to the consumer;
12. “Rebate” includes but is not limited to the following:
SB721 HFLR Page 5
BOLD FACE denotes Committee Amendments. 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
a. negotiated price concessions including but not limited
to base rebates and reasonable estimates of any price
protection rebates and performance -based rebates that
may accrue directly or indirectly to the health
insurer or pharmacy benefit manager as a result of
point of sale prescription medication claims
processing during the coverage year from a
manufacturer, dispensing pharmacy or other party to
the transaction, or
b. reasonable estimates of any fees and other
administrative costs that are passed through to the
health insurer as a result of point of sale
prescription medication claims processing and serve to
reduce the health insurer’s prescription medicati on
liabilities for the coverage year; and
13. “Provider contract” means any contract between a provider
and a health insurer, or an insurer’s network, provider panel,
intermediary or representative , relating to the provision of health
care services.
SECTION 3. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 6971 of Title 36, unless there
is created a duplication in numbering, reads as follows:
A. Health insurers and pharmacy benefit managers that issue,
renew, or amend health benefit plans with prescription drug coverage
SB721 HFLR Page 6
BOLD FACE denotes Committee Amendments. 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
in this state are prohibited from imposing excess cost burden on an
insured.
B. When contracting with a health insurer or health benefit
plan to administer pharmacy benefits, a pharm acy benefits manager
shall offer the carrier or health plan the option of extending
point-of-sale rebates to enrollees of the plan .
C. Prescription drug cost sharing for an insured shall be the
lesser of:
1. The applicable co -payment for the prescription medication
that would be payable in the absence of this section;
2. The maximum allowable cost;
3. The maximum allowable claim;
4. The adjusted out -of-pocket amount as determined pursuant to
Section 2 of this act;
5. The amount an insured would pay fo r the prescription
medication if they purchased it without using their health benefit
plan or any other source of prescription medication benefits or
discounts; or
6. The amount the pharmacy will be reimbursed for the
prescription medication by the health insurer or pharmacy benefit
manager.
D. The Insurance Commissioner shall promulgate rules and
regulations to implement the provisions of this section.
SB721 HFLR Page 7
BOLD FACE denotes Committee Amendments. 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
SECTION 4. This act shall become effective November 1, 2021.
COMMITTEE REPORT BY: CO MMITTEE ON PUBLIC HEALTH, dated 04/07/2021 -
DO PASS.