Compare Versions - OK SB13 : Oklahoma 2023 Regular Session

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28	53		STATE OF OKLAHOMA
29	54
30	55		1st Session of the 59th Legislature (2023)
31	56
32		-	COMMITTEE SUBSTITUTE
33		-	FOR
34	57		SENATE BILL 13 By: Garvin
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36	59
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40		-	~~COMMITTEE SUBSTITUTE~~
	63	+	AS INTRODUCED
41	64
42	65		An Act relating to pharmaceuticals; defining terms;
43		-	requiring health benefit plans to adhere to certain
44		-	requirements; requiring certain drugs to meet federal
45		-	requirements; prohibiting plans from imposing certain
46		-	requirements or payments; establishing certain drug
47		-	administration requirements; creating a penalty;
48		-	providing for codification; and declaring an
49		-	emergency.
	66	+	prohibiting certain drug plans from refusing certain
	67	+	dispensing of physician-administered or injectable
	68	+	drugs under certain circumstances ; requiring certain
	69	+	drugs meet certain federal requirements; prohibiting
	70	+	patients from payment of certain fees beyond cost-
	71	+	sharing obligation; establishing penalties; providing
	72	+	immunity from liability to c ertain providers;
	73	+	providing for codification; and provi ding an
	74	+	effective date.
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54	79		BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
55	80		SECTION 1. NEW LAW A new section o f law to be codified
56	81		in the Oklahoma Statutes as Sect ion 6969 of Title 36, unless there
57	82		is created a duplication in numb ering, reads as follows:
58	83		A. As used in this section:
59		-	1. “Health benefit plan” means a health benefit plan as defined
60		-	pursuant to Section 6060.4 of Title 36 of the Oklah oma Statutes;
61		-	2. “Pharmacy benefits manager” means a person that performs
62		-	pharmacy benefits management and any other person acting for such
63		-	person under a contractual or employment relationship in the
64		-	performance of pharmacy benefits management for a mana ged-care
	84	+	1. “Health care provider” means a provider as defined pursuant
	85	+	to Section 6571 of Title 36 of the Oklahoma Statu tes;
	86	+	2. “Pharmacy benefits manager” means a manager as defined
	87	+	pursuant to Section 6960 of Title 36 of the Oklahoma Statutes; and
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91		-	company, not-for-profit hospital, medical serv ices organization,
92		-	insurance company, third-party payor, or a health program
93		-	administered by a state agency ; and
94		-	3. “White bagged drugs” means the distribution of physician -
95		-	administered medication from a pharmacy, typically a specialty
96		-	pharmacy, to the physician’s office, hospital, or clinic for
97		-	administration.
98		-	B. All health benefit plans and pharmacy benefits managers in
99		-	this state shall not refuse to authorize, approv e, or pay a
100		-	participating provider for providing covered physician-administered
101		-	drugs to covered persons.
	139	+	3. “White bagged drugs” means a patient-specific medication
	140	+	distributed from a pharmacy, typically a third-party specialty
	141	+	pharmacy, to a health care provider for administration.
	142	+	B. In the event that a health care provider dispenses or
	143	+	administers a white bag ged drug to a patient, that patient’s
	144	+	pharmaceutical drug plan or the pharmac y benefits manager of the
	145	+	drug plan shall not refuse to approve, authorize, or pay the third-
	146	+	party specialty pharmacy for the drug solely because the drug is a
	147	+	white bagged drug.
102	148		C. All white bagged drugs distributed in this state shall meet
103	149		supply chain securit y controls set forth by the federal Drug Supply
104		-	Chain Security Act as amended.
105		-	D. A health benefit plan or a pharmacy benefits manager of a
106		-	plan shall not require a covered patient to self-administer an
107		-	injectable drug against a health care provider’s recommendation in
108		-	accordance with the manufacturer ’s approved guidelines .
109		-	E. Health benefit plans shall not require a covered patient to
110		-	pay additional fees for white bagged drugs beyond cost-sharing
111		-	obligations as outlined in the individual ’s plan.
112		-	F. Providers and health care facilities shall be permitted to
113		-	dispense and administer a covered physician-administered drug based
114		-	on a patient’s best interest, provided that the health care facility
	150	+	Chain Security Act as amended. The State Board of Pharmacy may
	151	+	promulgate rules related to supply, storage, and transaction history
	152	+	to ensure that white bagged drugs are in compliance with federal
	153	+	law.
	154	+	D. A pharmaceutical drug plan or a pharmacy benefits manager of
	155	+	a plan shall not require a covered patient to self-administer an
	156	+	injectable white bagged drug against a health care provider’s
	157	+	recommendation.
	158	+	E. A pharmaceutical drug plan or a pharmacy benefits manager of
	159	+	a plan shall not require a covered patient to pay additional fees
	160	+	for white bagged drugs beyond cost-sharing obligations as outlined
	161	+	in the individual’s plan.
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141		-	or provider that administers the drug shall agree to the terms and
142		-	conditions of network participation and accept, as payment in full,
143		-	reimbursement for the drug at the health insurer’s or pharmacy
144		-	benefits manager’s negotiated contracted rate . The health care
145		-	facility or provider is prohibited from billing or collecting from
146		-	the patient any amount in excess of or in addition to the patient’s
147		-	cost sharing obligations as outlined in the individual’s plan.
148		-	G. Any payor in violation of this act shall be fined a minimum
149		-	of Five Thousand Dollars ($5,000.00) per violation, but not more
150		-	than Ten Thousand Dollar s ($10,000.00) per violati on. Fines related
151		-	to this section shall not be used when calculating pay ors, plans, or
152		-	members loss ratios and lo sses incurred pursuant to this subsection
153		-	shall not be passed on to the consumer in future rate increases.
154		-	H. A health care provider or facility shall be immune from
155		-	civil liability for any lo ss or harm to a person due to his or her
156		-	health insurance plan utilizin g white bagged drugs caused by an act
157		-	or omission by the facility or provider that occurs during the
158		-	process outlined in this act if the act or omission was not the
159		-	result of gross negligenc e or willful or wanton misconduct o f the
160		-	health care facility o r health care provider rendering the health
161		-	care services.
162		-	SECTION 2. It being immediately necessary for the pr eservation
163		-	of the public peace, health or safety, an emergency is hereby
	213	+	F. Any pharmaceutical drug plan or pharmacy benefits manager in
	214	+	violation of this act shall be fined a minimum of Five Thousan d
	215	+	Dollars ($5,000.00) per violation, but not more than Ten Thousand
	216	+	Dollars ($10,000.00) per violati on. Fines related to this section
	217	+	shall not be used when calculating pay ers, plans, or members loss
	218	+	ratios and losses incurred pursuant to this subsection shall not be
	219	+	passed on to the insured in future rate increases.
	220	+	G. A health care provider shall be immune from civil liability
	221	+	for any loss or harm to a person due to his or her health insurance
	222	+	plan utilizing white bagged drugs caused by an act or omission by
	223	+	the facility or provider that occurs during the process outlined in
	224	+	this act if the act or omission was not the result of gross
	225	+	negligence or willful or wanton misconduct o f the health care
	226	+	facility or health care provider rendering the health care servic es.
	227	+	SECTION 2. This act shall become effective November 1 , 2023.
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190		-	declared to exist, by reason whereof this act shall take e ffect and
191		-	be in full force from an d after its passage and approval.
192		-
193		-	59-1-1734 RD 2/8/2023 9:50:05 AM
	229	+	59-1-424 RD 12/6/2022 11:23:52 AM

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or provider that administers the drug shall agree to the terms and

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conditions of network participation and accept, as payment in full,

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reimbursement for the drug at the health insurer’s or pharmacy

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benefits manager’s negotiated contracted rate . The health care

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facility or provider is prohibited from billing or collecting from

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the patient any amount in excess of or in addition to the patient’s

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cost sharing obligations as outlined in the individual’s plan.

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G. Any payor in violation of this act shall be fined a minimum

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of Five Thousand Dollars ($5,000.00) per violation, but not more

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than Ten Thousand Dollar s ($10,000.00) per violati on. Fines related

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to this section shall not be used when calculating pay ors, plans, or

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members loss ratios and lo sses incurred pursuant to this subsection

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shall not be passed on to the consumer in future rate increases.

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H. A health care provider or facility shall be immune from

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civil liability for any lo ss or harm to a person due to his or her

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health insurance plan utilizin g white bagged drugs caused by an act

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or omission by the facility or provider that occurs during the

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process outlined in this act if the act or omission was not the

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result of gross negligenc e or willful or wanton misconduct o f the

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health care facility o r health care provider rendering the health

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care services.

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SECTION 2. It being immediately necessary for the pr eservation

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of the public peace, health or safety, an emergency is hereby

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F. Any pharmaceutical drug plan or pharmacy benefits manager in

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violation of this act shall be fined a minimum of Five Thousan d

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Dollars ($5,000.00) per violation, but not more than Ten Thousand

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+

Dollars ($10,000.00) per violati on. Fines related to this section

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shall not be used when calculating pay ers, plans, or members loss

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+

ratios and losses incurred pursuant to this subsection shall not be

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+

passed on to the insured in future rate increases.

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G. A health care provider shall be immune from civil liability

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for any loss or harm to a person due to his or her health insurance

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+

plan utilizing white bagged drugs caused by an act or omission by

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the facility or provider that occurs during the process outlined in

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this act if the act or omission was not the result of gross

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+

negligence or willful or wanton misconduct o f the health care

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+

facility or health care provider rendering the health care servic es.

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+

SECTION 2. This act shall become effective November 1 , 2023.

Oklahoma 2023 Regular Session

Oklahoma Senate Bill SB13 Compare Versions