An Act
ENROLLED SENATE
BILL NO. 821 By: McCortney, Murdock, Kidd,
Pemberton, Stephens, Garvin,
Stanley, Bullard, Rogers,
Standridge, Hicks, Weaver,
Jett, Dugger, Simpson,
Hamilton, Hall, Jech, Taylor ,
Boren, Pederson, Allen,
Coleman, Burns, Bergstrom ,
Dossett (J.J.) and Dossett
(J.A.) of the Senate
and
McEntire, Moore, Frix, Gre go,
Pae, Boles, Davis, Marti,
Dempsey, Hilbert, Olsen,
Phillips, Johns, Humphrey,
Sterling, Fugate, West
(Tammy), Kerbs, Vancuren,
Gann, Smith, McBride,
Hasenbeck, Roe, Dobrinski,
Kendrix, Caldwell (Chad ),
Ranson, Hardin (David),
Fetgatter, O'Donnell, Virgin,
May, Roberts (Dustin),
Newton, Lowe (Dick), Talley,
Randleman, West (Josh),
McCall, Townley, Conley,
Burns, Boatman, Cornwell,
Bashore, Strom, Miller,
Lawson, Luttrell, Cul ver,
Russ, Ford, Sims, McDugle,
Walke, Cruz, Wallace, Echols,
Nichols, Provenzano,
Patzkowsky, Manger, Bush,
Worthen, Bennett, Crosswhite
Hader, West (Kevin),
Rosecrants, Williams, Sneed,
Caldwell (Trey), Baker and
Lepak of the House
ENR. S. B. NO. 821 Page 2
An Act relating to the Patient’s Right to Pharmacy
Choice Act; amending Section 3, Chapter 426, O.S.L.
2019 (36 O.S. Supp. 2020, Section 6960), which
relates to definitions; adding definitions of
pharmacy benefits manag ement and retail pharmacy;
modifying definitions; amending Section 4, Chapter
426, O.S.L. 2019 (36 O.S. Supp. 2020, Section 6961),
which relates to retail pharmacy network access
standards; specifying access standards; modifying
prohibition on pharmacy benefit managers; amending
Section 5, Chapter 426, O.S.L. 2019 ( 36 O.S. Supp.
2020, Section 6962), which relates to compliance
review; modifying certain contract restrictions;
updating statutory reference; amending Section 6,
Chapter 426, O.S.L. 2019 (36 O.S. Supp. 2020, Section
6963), which relates to health insurer monitoring;
modifying certain prohibitions on health insurers and
pharmacy benefit managers ; conforming language;
repealing Section 7, Chapter 426, O.S.L. 2019 (36
O.S. Supp. 2020, Section 6964), which relates to
health insurer formularies; and providing an
effective date.
SUBJECT: Patient's Right to Pharmac y Choice Act
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKL AHOMA:
SECTION 1. AMENDATORY Section 3, Chapter 426, O.S.L.
2019 (36 O.S. Supp. 2020, Section 6960), is amended to read as
follows:
Section 6960. For purposes of the Pati ent’s Right to Pharmacy
Choice Act:
1. “Health insurer” means any corporation, association, benefit
society, exchange, partnership or individual licensed by the
Oklahoma Insurance Code;
ENR. S. B. NO. 821 Page 3
2. “Mail-order pharmacy” means a pharmacy lice nsed by this
state that primarily dispenses and delivers covered drugs via common
carrier;
3. “Pharmacy benefits management” means any or all of the
following activities:
a. provider contract negotiation and/or provider network
administration including decisions related to provider
network participation stat us,
b. drug rebate contract negotiation or drug rebate
administration, and
c. claims processing which may include claim billing a nd
payment services;
4. “Pharmacy benefits manager” or “PBM” means a person or
entity that performs pharmacy benefits manage ment activities and any
other person or entity acting for such a person or entity performing
pharmacy benefits management activities under a contractual or
employment relationship in the performance of p harmacy benefits
management for a managed-care company, nonprofit hospital, medica l
service organization, insurance company, third-party payor or a
health program administered by a department of this state;
4. “Pharmacy and therapeutics committee” or “P&T committee”
means a committee at a hospital or a heal th insurance plan that
decides which drugs will appear on that entity’s drug formulary;
5. “Retail pharmacy” or “provider” means a pharmacy, as defined
in Section 353.1 of Title 59 of the Oklahoma Statu tes licensed by
the State Board of Pharmacy or an age nt or representative of a
pharmacy;
5. 6. “Retail pharmacy network” means retail pharmacy providers
contracted with a PBM in which the pharmacy primarily fills and
sells prescriptions via a retail, stor efront location;
ENR. S. B. NO. 821 Page 4
6. 7. “Rural service area” means a five-digit ZIP code in which
the population density is less than one thousand (1,000) individuals
per square mile;
7. 8. “Suburban service area” means a five-digit ZIP code in
which the population densi ty is between one thousand (1,000) and
three thousand (3,000) individuals per square mile; and
8. 9. “Urban service area” means a five-digit ZIP code in which
the population density i s greater than three thousand (3,000)
individuals per square mile.
SECTION 2. AMENDATORY Section 4 , Chapter 426, O.S.L.
2019 (36 O.S. Supp. 202 0, Section 6961), is amended to read as
follows:
Section 6961. A. Pharmacy benefits m anagers (PBMs) shall
comply with the following retail pharmacy network access standards:
1. At least ninety percent (90%) of covered individuals
residing in an each urban service area live within two (2) miles of
a retail pharmacy participating in the PBM ’s retail pharmacy
network;
2. At least ninety percent (90%) of covere d individuals
residing in an each urban service area live within five (5) miles of
a retail pharmacy designated as a preferred participating pharmacy
in the PBM’s retail pharmacy networ k;
3. At least ninety percent (90%) of covered individuals
residing in a each suburban service area live within five (5) miles
of a retail pharmacy participating in the PBM’s retail pharmacy
network;
4. At least ninety percent (90%) of covered individual s
residing in a each suburban service area live within seven (7) miles
of a retail pharmacy design ated as a preferred participating
pharmacy in the PBM’s retail pharmacy network;
5. At least seventy percent (70%) of covered individuals
residing in a each rural service area live within fifteen (15) miles
ENR. S. B. NO. 821 Page 5
of a retail pharmacy participating in the PBM ’s retail pharmacy
network; and
6. At least seventy percent (70%) of cove red individuals
residing in a each rural service area live within eighteen (18)
miles of a retail pharmacy designated as a preferred participating
pharmacy in the PBM’s retail pharmacy network.
B. Mail-order pharmacies shall not be used to meet access
standards for retail pharmacy networks.
C. Pharmacy benefits managers shall not require p atients to use
pharmacies that are directly or indirectly owned by the or
affiliated with a pharmacy benefits manager, including all regular
prescriptions, refills or sp ecialty drugs regardless of day supply.
D. Pharmacy benefits managers shall not in any manner on any
material, including but not limited to mail and ID cards , include
the name of any pharmacy, hospital or other providers unless it
specifically lists all p harmacies, hospitals and providers
participating in the preferred and nonpreferred phar macy and health
networks.
SECTION 3. AMENDATORY Section 5, Chapter 426, O.S.L.
2019 (36 O.S. Supp. 2020, Section 6962), is amended to read as
follows:
Section 6962. A. The Oklahoma Insurance Department shall
review and approve r etail pharmacy network access for all ph armacy
benefits managers (PBMs) to ensure compliance with Section 4 of this
act 6961 of this title.
B. A PBM, or an agent of a PBM, shall n ot:
1. Cause or knowingly permit the use of advertisement,
promotion, solicitation , representation, proposal or offer that is
untrue, deceptive or misleading;
2. Charge a pharmacist or pharma cy a fee related to the
adjudication of a claim , including without limitation a fee for:
a. the submission of a claim,
ENR. S. B. NO. 821 Page 6
b. enrollment or partici pation in a retail pharmacy
network, or
c. the development or management of claims proc essing
services or claims payment services related to
participation in a retail pharmacy network;
3. Reimburse a pharmacy or pharmacist in the state an amount
less than the amount that the PBM reimburses a pharmacy owned by or
under common ownership with a PBM for providing the sa me covered
services. The reimbursement amount paid to the phar macy shall be
equal to the reimbursement amount calculated on a per -unit basis
using the same generic product identifier or generic code number
paid to the PBM-owned or PBM-affiliated pharmacy;
4. Deny a pharmacy the opportunity to participate in any form
of pharmacy network at preferred participation status, whether in-
network, preferred or otherwise, if the pharmacy is willing to
accept the terms and conditions that the PBM has establish ed for
other pharmacies as a condition of preferred network for
participation status in the network or networks of the pharmacy’s
choice;
5. Deny, limit or terminate a pharmacy’s contract based on
employment status of any employee wh o has an active license to
dispense, despite probation status, with the State Board of
Pharmacy;
6. Retroactively den y or reduce reimbursement for a covered
service claim after returning a paid claim response as part of the
adjudication of the claim, unle ss:
a. the original claim was submitted fraudulently, or
b. to correct errors identified in an audit, so long as
the audit was conducted in compliance with Section s
356.2 and 356.3 of Title 59 of the Oklahoma Statutes;
or
ENR. S. B. NO. 821 Page 7
7. Fail to make any payment due t o a pharmacy or pharmacist for
covered services properly rendered in the event a PBM terminates a
pharmacy or pharmaci st from a pharmacy benefits manager network.
C. The prohibitions under this section shall apply to contracts
between pharmacy benefits ma nagers and pharmacists or pharmacies
providers for participation in retail ph armacy networks.
1. A PBM provider contract shall not prohibit, restrict or
penalize a pharmacy or pharmacist in any way for disclosing to an
individual any health care informati on that the pharmacy or
pharmacist deems appropriate regarding :
a. not restrict, directly or indirectly, any pharmacy
that dispenses a prescription drug from informing, or
penalize such pharmacy for informing, an individual of
any differential between the individual’s out-of-
pocket cost or coverage with respect to acquisition of
the drug and the amount an individual would pay to
purchase the drug directly the nature of treatment,
risks or alternatives to the prescription drug being
dispensed, and
b. ensure that any entity that provi des pharmacy benefits
management services under a c ontract with any such
health plan or health insurance coverage does not,
with respect to such plan or co verage, restrict,
directly or indirectly, a pharmacy that dispenses a
prescription drug from informin g, or penalize such
pharmacy for informing, a cover ed individual of any
differential between the individual’s out-of-pocket
cost under the plan or coverage with respect to
acquisition of the drug and the amount an individual
would pay for acquisition of th e drug without using
any health plan or health insu rance coverage the
availability of altern ate therapies, consultations or
tests,
c. the decision of utili zation reviewers or similar
persons to authorize or deny services, and
ENR. S. B. NO. 821 Page 8
d. the process that is used to authorize or deny
healthcare services and struct ures used by the health
insurer.
2. Provider contracts shall not prohibit a pha rmacy or
pharmacist from discussing information regarding the total cost of
pharmacist services for a prescription drug or from selling a more
affordable alternative to the cove red person if such alternative is
available.
A pharmacy benefits manager’s contract with a participating
pharmacist or pharmacy 3. Provider contracts shall not prohibit,
restrict or limit disclosure of inf ormation to the Insurance
Commissioner, law enf orcement or state and federal governmental
officials investigating or examining a complaint or conducting a
review of a pharmacy benefits manager’s compliance with the
requirements under the Patient’s Right to Pharmacy Choice Act.
3. 4. A pharmacy benefits manager shall establish and maintain
an electronic claim inquiry processing system using the National
Council for Prescription Drug Programs’ current standards to
communicate information to pharmacies submit ting claim inquiries.
SECTION 4. AMENDATORY Section 6, Chapter 426 , O.S.L.
2019 (36 O.S. Supp. 2020, Section 6963), is amended to read as
follows:
Section 6963. A. A health insurer shall be responsible for
monitoring all activities carried out by, or on behalf of, the
health insurer under the Patient’s Right to Pharmacy Choice Act, and
for ensuring that all requirements of this ac t are met.
B. Whenever a health insurer performs pharmacy benefit
management on its own behalf or contracts with another person or
entity to perform activities required under this act pharmacy
benefit management, the health insurer shall be responsible fo r
monitoring the activities and conduct of that person or entity with
whom the health insurer contracts and for ensuring that the
requirements of this act are met.
C. An individual may be no tified at the point of sale when the
cash price for the purchase of a prescription drug is less than the
ENR. S. B. NO. 821 Page 9
individual’s copayment or coinsuran ce price for the purchase of the
same prescription drug.
D. A health insurer or pharmacy benefits manager (PBM) sha ll
not restrict an individual’s choice of in-network provider for
prescription drugs.
E. An individual’s A patient’s choice of in-network provider
may include a retail an in-network pharmacy or a, whether that
pharmacy is in a preferred or nonpreferred network, a retailer
pharmacy, mail-order pharmacy or any other pharmacy. A health
insurer or PBM shall not restrict such a patient’s choice of in-
network pharmacy providers. Such A health insurer or PBM shall not
require or incentivize using individuals by:
1. Using any discounts in cost-sharing or a reduction in copay
or the number of copays to individuals to receive prescription drugs
from an individual’s choice of in-network pharmacy from an
individual’s choice of in-network pharmacy; or
2. Differentiating between in-network pharmacies, whether that
pharmacy is in a preferred or nonpreferred network, a retail
pharmacy, mail order pharmacy or any other type of pharmacy.
The provisions of this subsection shall not apply to any plan
subject to regulation und er Medicare Part D, 42 U.S.C. Section
1395w-101, et seq.
F. A health insurer, pharmacy or PBM shall adhere to all
Oklahoma laws, statut es and rules when mailing, shipping and/or
causing to be mailed or shipped prescriptio n drugs into the State of
Oklahoma this state.
SECTION 5. REPEALER Section 7, Chapter 426, O.S.L. 2019
(36 O.S. Supp. 2020, Section 6964), is hereby repealed.
SECTION 6. This act shall become effective Nove mber 1, 2021.
ENR. S. B. NO. 821 Page 10
Passed the Senate the 10th day of March, 2021.
Presiding Officer of the Senate
Passed the House of Representatives the 20th day of April, 2021.
Presiding Officer of the House
of Representatives
OFFICE OF THE GOVERNOR
Received by the Office of the Governor this _______ _____________
day of ___________________, 20_______, at _______ o'clock _______ M.
By: _______________________________ __
Approved by the Governor of the State of Oklahoma this _____ ____
day of _________________ __, 20_______, at _______ o'clock _______ M.
________________________ _________
Governor of the State of Oklahoma
OFFICE OF THE SECRETARY OF STATE
Received by the Office of the Secretary of State this _______ ___
day of __________________, 20 _______, at _______ o'clock _______ M.
By: _______________________________ __