An Act
ENROLLED HOUSE
BILL NO. 1843 By: Kerbs, Davis, Newton,
Grego, Maynard, Burns,
Roberts and Talley of the
House
and
McCortney, Bullard and
Stephens of the Senate
An Act relating to pharmacy benefit managers ;
amending 36 O.S. 2021, Section 6962, as amended by
Section 2, Chapter 38, O.S.L. 20 22 (36 O.S. Supp.
2022, Section 6962), which relates to compliance
review; replacing Insurance Commissioner with
Attorney General; amending 36 O.S. 2021 , Section
6965, which relates to power to inves tigate;
replacing investigative authority with the Attor ney
General; amending 36 O.S. 2021, Section 6966.1, as
amended by Section 3, Chapter 38, O.S.L. 2022 (36
O.S. Supp. 2022, Section 6966.1), which relates to
violations, penalties, and hearings; replacing
enforcement authority with the Attorney General ;
and providing an effective date.
SUBJECT: Pharmacy benefit managers
BE IT ENACTED BY THE P EOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 36 O.S. 2021, Section 69 62, as
amended by Section 2, Chapter 38, O.S.L. 2022 (36 O.S. Supp. 2022,
Section 6962), is amended to read as follows:
Section 6962. A. The Oklahoma Insurance Department Attorney
General shall review and approve retail pharmacy network access for
all pharmacy benefits managers (PBMs) to ensure compliance with
Section 6961 of this title.
B. A PBM, or an agent of a PBM, s hall not: ENR. H. B. NO. 1843 Page 2
1. Cause or knowingly pe rmit the use of advertisement,
promotion, solicitation, representation, proposal or offer that is
untrue, deceptive or misleading;
2. Charge a pharmacist or phar macy a fee related to the
adjudication of a claim including without limitation a fee for:
a. the submission of a claim,
b. enrollment or participation in a retail pharmacy
network, or
c. the development or management of claims processing
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 pharm acy owned by or
under common ownership with a PBM for providing the s ame covered
services. The reimbursement amount paid to the pharmacy 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 provider the opportunity to participate in any
pharmacy network at preferred participation status if the provider
is willing to accept the terms and conditions that the PBM has
established for other providers as a condition of preferred networ k
participation status;
5. Deny, limit or terminate a provider's contract based on
employment status of a ny employee who has an active license to
dispense, despite probation status, wi th the State Board of
Pharmacy;
6. Retroactively deny or reduce reimbu rsement for a covered
service claim after returning a paid claim response as part of the
adjudication of the claim, unless:
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 Sections
356.2 and 356.3 of Title 59 of the Oklahoma Statutes; ENR. H. B. NO. 1843 Page 3
7. Fail to make any pa yment due to a pharmacy or pharmacist for
covered services properly re ndered in the event a PBM terminates a
provider from a pharmacy benefits manager network;
8. Conduct or practice spread pricing, as defined in Section 1
of this act, in this state; or
9. Charge a pharmacist or pharmacy a fee related to
participation in a re tail pharmacy network including but not limited
to the following:
a. an application fee,
b. an enrollment or participation fee,
c. a credentialing or re-credentialing fee,
d. a change of ownership fee, or
e. a fee for the development or management of claims
processing services or claims payment services .
C. The prohibitions under this section shall apply to contracts
between pharmacy benefits managers and providers for participation
in retail pharmacy networks.
1. A PBM contract shall:
a. not restrict, directly or indirectly, any pharmacy
that dispenses a presc ription drug from informing, or
penalize such pharmacy for informing, an indivi dual 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, and
b. ensure that any entity that provides pharmacy benefits
management services under a contract with any such
health plan or health insurance coverage does not,
with respect to such plan or coverage, restrict,
directly or indirectly, a ph armacy that dispenses a
prescription drug from inf orming, or penalize such
pharmacy for informing, a covered individual of any
differential between the individual 's out-of-pocket ENR. H. B. NO. 1843 Page 4
cost under the plan or coverage with respect to
acquisition of the drug and t he amount an individual
would pay for acquisition of the drug without using
any health plan or health insurance coverage.
2. A pharmacy benefits manager 's contract with a provider shall
not prohibit, restrict or limit disclosure of information to the
Insurance Commissioner Attorney General, law enforcement 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.
D. A pharmacy benefits manager shall:
1. Establish and maintain an elect ronic claim inquiry
processing system using the National Council for Prescription Drug
Programs' current standards to communicate information to pharmacies
submitting claim inquiries ;
2. Fully disclose to insurer s, self-funded employers, unions or
other PBM clients the existence of the re spective aggregate
prescription drug discounts, rebates rece ived from drug
manufacturers and pharmacy audit recoupments;
3. Provide the Insurance Commissioner Attorney General,
insurers, self-funded employer plans an d unions unrestricted audi t
rights of and access to the respective PBM pharmaceutical
manufacturer and provider contracts, plan utilization data, plan
pricing data, pharmacy utilization dat a and pharmacy pricing data;
4. Maintain, for no less than three (3) years, documentation of
all network development activities including but not limited to
contract negotiations and any denials to providers to join networks.
This documentation shall be made available to the Commissioner
Attorney General upon request;
5. Report to the Commissioner Attorney General, on a quarterly
basis for each health insurer pay or, on the following information:
a. the aggregate amount of rebates received by t he PBM,
b. the aggregate amount of rebates distributed to the
appropriate health in surer payor,
ENR. H. B. NO. 1843 Page 5
c. the aggregate amount of rebates passed on to the
enrollees of each healt h insurer payor at the point of
sale that reduced the applicable deductible,
copayment, coinsure or other cost sharing amount of
the enrollee,
d. the individual and agg regate amount paid by t he health
insurer payor to the P BM for pharmacy services
itemized by pharmacy, drug product and service
provided, and
e. the individual and aggreg ate amount a PBM paid a
provider for pharmac y services itemized by pharmacy,
drug product and service provide d.
SECTION 2. AMENDATORY 36 O.S. 2021 , Section 6965, is
amended to read as follows:
Section 6965. A. The Insurance Commissioner Attorney General
shall have power and authority to examine and investigat e the
affairs of every pharmacy benefi ts manager (PBM) engaged in pharmacy
benefits management in this state in order to determine whet her such
entity is in compliance with the Patient 's Right to Pharmacy Choic e
Act.
B. All PBM files and records shall be subject to examination by
the Insurance Commissioner Attorney General or by duly appointed
designees. The Insurance Commissioner Attorney General, authorized
employees and examiners shall have access to any of a PBM's files
and records that may relate to a particular complaint under
investigation or to an inquiry or examination by the Insurance
Department Attorney General.
C. Every officer, director, employee or agent of the PBM, upon
receipt of any inquiry fr om the Commissioner Attorney General shall,
within twenty (20) days from the date the inquiry is sent , furnish
the Commissioner Attorney General with an adequate response to the
inquiry.
D. When making an examination under this sectio n, the Insurance
Commissioner Attorney General may retain subject matter experts,
attorneys, appraisers, independent actua ries, independent certified
public accountants or an accounting firm or individual holding a
permit to practice public accounting, cer tified financial examiners
or other professionals and specialists as examiners, the cost of ENR. H. B. NO. 1843 Page 6
which shall be borne by the PB M that is the subject of the
examination.
SECTION 3. AMENDATORY 36 O.S. 2021, Section 6966.1, as
amended by Section 3, Chapter 38, O.S.L . 2022 (36 O.S. Supp. 2022,
Section 6966.1), is amende d to read as follows:
Section 6966.1 A. The Insurance Commissioner may censure,
suspend, revoke or refuse to issue or renew a license of or levy a
civil penalty against any person licensed under the insurance laws
of this state for any violation of the Patient's Right to Pharmacy
Choice Act, Section 6958 et seq. of Title 6 of the Oklahoma Statutes
this title.
B. 1. If the Commissioner Attorney General finds, after notice
and opportunity for hearing, that a pharmacy benefits manager (PBM)
violated one or more provisions of the Patient's Right to Pharmacy
Choice Act, the Pharmacy Audit Integrity Act or the provisions of
Sections 357 through 360 of Title 59 of the Oklahoma Statues, the
Attorney General may recommend the PBM may be censured, his or her
license may be suspended or rev oked and a penalty or remedy
authorized by this act may be imposed. If the Attorney General
makes such recommendation, the Commissioner shall take the
recommended action.
2. In addition to or in lieu of any censure, suspension or
revocation of a license, a PBM may be subject to a civil fine of not
less than One Hundred Dollars ($100.00) and not greater tha n Ten
Thousand Dollars ($10,000.00) for each violation of the provisions
of the Patient's Right to Pharmacy Choice Act, the Pharmacy Audit
Integrity Act or the provis ions of Sections 357 throug h 360 of Title
59 of the Oklahoma Statues, following notice and an opportunity for
a hearing.
C. Notwithstanding whether the license of a PBM has been
issued, suspended, revoke d, surrendered or lapsed by operation of
law, the Commissioner Attorney General is hereby authorized to
enforce the provisions of the Patient 's Right to Pharmacy Cho ice Act
and impose any penalty or remedy authorized under the act against a
PBM under investigation for or charg ed with a violation of the
Patient's Right to Pharmacy Ch oice Act, the Pharmacy Audit Integrity
Act, the provisions of Se ctions 357 through 360 of Title 59 of the
Oklahoma Statues or any provisi on of the insurance laws of this
state.
ENR. H. B. NO. 1843 Page 7
D. Each day that a P BM conducts business in this sta te without
a license from the Insurance Department shall be deemed a violation
of the Patient's Right to Pharmacy Choice Act.
E. 1. All hearings conducted by the Insurance Department
Office of the Attorney General pursuant to this section shall be
public and held in accordance with the Administrative Procedures
Act.
2. Hearings shall be held at the office of the Insurance
Commissioner Attorney General or any other place the Commissioner
Attorney General may deem convenient.
3. The Commissioner Attorney General, upon written request from
a PBM affected by the hearing, shall cause a full sten ographic
record of the proceedings to be made by a competent court reporter.
This record shall be at the expense of the PBM.
4. The ordinary fees and cost s of the hearing examiner
appointed pursuant to Section 319 of Title 36 of the Oklahoma
Statutes this title may be assessed by the hea ring examiner against
the respondent unless the respondent is the prevailing party.
F. Any PBM whose license has been censured, susp ended, revoked
or denied renewal or who has had a fine levied against him or her
shall have the right of appeal from the fi nal order of the Insurance
Commissioner Attorney General, pursuant to Section 318 et seq. of
Title 75 of the Oklahoma Statutes.
G. If the Insurance Commissioner Attorney General determines,
based upon an investigation of complaints, that a PBM has engaged in
violations of the provisions of the Patient's Right to Pharmacy
Choice Act with such frequency as to indicate a general business
practice, and that the PBM should be subjected to closer supervision
with respect to thos e practices, the Commissioner Attorney General
may require the PBM to file a report at any peri odic interval the
Commissioner Attorney General deems necessary.
SECTION 4. This act shall become effective November 1, 2023.
ENR. H. B. NO. 1843 Page 8
Passed the House of Representatives the 21st day of March, 2023.
Presiding Officer of the House
of Representatives
Passed the Senate the 25th day of April, 2023.
Presiding Officer of the Senate
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: _________________________________