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STATE OF OKLAHOMA
1st Session of the 59th Leg islature (2023)
HOUSE BILL 1598 By: Martinez
AS INTRODUCED
An Act relating to insurance; amending 36 O.S. 2021,
Section 6961, which relates to retail pharmacy
network access standards; remov ing the State
standards for network access; adding the Federal
standards for network access; and providing an
effective date.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 36 O.S. 2021, Section 6961, is
amended to read as follows :
Section 6961. A. Pharmacy benefits managers (PBMs) shall
comply with the following retail pharmacy network access standards:
1. At least ninety percent (90%) of covered individuals
residing in an urban service a rea live within two (2) miles of a
retail pharmacy participating in the PBM 's retail pharmacy network;
2. At least ninety percent (90%) of covered individuals
residing in an urban service area live wit hin five (5) miles of a
retail pharmacy designated as a preferred participating pharmacy in
the PBM's retail pharmacy network;
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3. At least ninety percent (90%) of covered individuals
residing in a 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 individuals
residing in a suburban service area live within seven (7) miles of a
retail pharmacy designated as a preferred participating pharmacy i n
the PBM's retail pharmacy network;
5. At least seventy percent (70%) of covered individuals
residing in a rural service area live within fifteen (15) miles of a
retail pharmacy participating in the PBM 's retail pharmacy network;
and
6. At least seventy percent (70%) of covered individuals
residing in a 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. For all retail pharmacy
networks managed by p harmacy benefits managers (PBMs) in the State
of Oklahoma, each PBM shall comply with the pharmacy network access
standards set forth under Federal law at 42 CFR 423.120(a)(1)
(Standards for convenient access to network pharmacies) as the same
may be amended from time to time.
B. Mail-order pharmacies shall not be used to meet access
standards for retail pharmacy networks.
C. Pharmacy benefits managers shall not require patients to use
pharmacies that are directly or indirectly owned by the pharmacy
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benefits manager, including all regular prescriptions, refi lls or
specialty 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 pharmacies, hospitals and providers
participating in the prefe rred and nonpreferred pharmacy and health
networks.
SECTION 2. This act shall become effective November 1, 2023.
59-1-5138 TJ 12/19/22