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STATE OF OKLAHOMA
1st Session of the 59th Legislature (2023)
COMMITTEE SUBSTITUTE
FOR
SENATE BILL 13 By: Garvin
COMMITTEE SUBSTITUTE
An Act relating to pharmaceuticals; defining ter ms;
requiring health benefit plans to adhere to certain
requirements; requiring certain drugs to meet federal
requirements; prohibiting plans from imposing certain
requirements or payments; establishing certain drug
administration requirements; creating a penalty;
providing for codification; and declaring an
emergency.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new section o f law to be codified
in the Oklahoma Statutes as Sect ion 6969 of Title 36, unless there
is created a duplication in numb ering, reads as follows:
A. As used in this section:
1. “Health benefit plan” means a health benefit plan as defined
pursuant to Section 6060.4 of Title 36 of the Oklah oma Statutes;
2. “Pharmacy benefits manager” means a person that performs
pharmacy benefits management and any other person acting for such
person under a contractual or employment relationship in the
performance of pharmacy benefits management for a mana ged-care
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company, not-for-profit hospital, medical serv ices organization,
insurance company, third-party payor, or a health program
administered by a state agency ; and
3. “White bagged drugs” means the distribution of physician -
administered medication from a pharmacy, typically a specialty
pharmacy, to the physician’s office, hospital, or clinic for
administration.
B. All health benefit plans and pharmacy benefits managers in
this state shall not refuse to authorize, approv e, or pay a
participating provider for providing covered physician-administered
drugs to covered persons.
C. All white bagged drugs distributed in this state shall meet
supply chain securit y controls set forth by the f ederal Drug Supply
Chain Security Act as amended.
D. A health benefit plan or a pharmacy benefits manager of a
plan shall not require a covered patient to self-administer an
injectable drug against a health care provider’s recommendation in
accordance with the manufacturer ’s approved guidelines .
E. Health benefit plans shall not require a covered patient to
pay additional fees for white bagged drugs beyond cost-sharing
obligations as outlined in the individual ’s plan.
F. Providers and health care facilities shall be permitted to
dispense and administer a covered physician-administered drug based
on a patient’s best interest, provided that the health care facility
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or provider that administers the drug shall agree to the terms and
conditions of network participation and accept, as payment in full,
reimbursement for the drug at the health insurer’s or pharmacy
benefits manager’s negotiated contracted rate . The health care
facility or provider is prohibited from billing or collecting from
the patient any amount in excess of or in addition to the patient’s
cost sharing obligations as outlined in the individual’s plan.
G. Any payor in violation of this act shall be fined a minimum
of Five Thousand Dollars ($5,000.00) per violation, but not more
than Ten Thousand Dollar s ($10,000.00) per violati on. Fines related
to this section shall not be used when calculating pay ors, plans, or
members loss ratios and lo sses incurred pursuant to this subsection
shall not be passed on to the consumer in future rate increases.
H. A health care provider or facility shall be immune from
civil liability for any lo ss or harm to a person due to his or her
health insurance plan utilizin g white bagged drugs caused by an act
or omission by the facility or provider that occurs during the
process outlined in this act if the act or omission was not the
result of gross negligenc e or willful or wanton misconduct o f the
health care facility o r health care provider rendering the health
care services.
SECTION 2. It being immediately necessary for the pr eservation
of the public peace, health or safety, an emergency is hereby
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declared to exist, by reason whereof this act shall take e ffect and
be in full force from an d after its passage and approval.
59-1-1734 RD 2/8/2023 9:50:05 AM