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STATE OF OKLAHOMA
1st Session of the 59th Legislature (2023)
SENATE BILL 145 By: Hicks
AS INTRODUCED
An Act relating to prescription drugs; definin g
terms; prohibiting an insurer from modifying coverage
under certain conditions with certain exceptions;
providing for certain civil penalty; requiring
promulgation of rules; providing for codification;
and providing an effective date .
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 6850.2 of Title 36, unless there
is created a duplication in numb ering, reads as follows:
A. As used in this section:
1. “Insurer” means an insurer as defined pursuant to Section
6054 of Title 36 of the Oklahoma Statutes;
2. “Practitioner” means a practitioner as defined pursuant to
Section 6054 of Title 36 of the Oklahoma Statutes; and
3. “Prescription drug” or “drug” means a prescription drug as
defined pursuant to Section 367.2 of Title 59 of the Oklahoma
Statutes.
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B. An insurer shall not modify an insured’s coverage of a
prescription drug if the following conditions are met:
1. The drug had been previously preauthorized for coverage by
the insurer or was listed on the formulary o f the insurer at the
time the insured was prescribed the drug by his or her practitioner;
2. The insured has already received the drug; and
3. A practitioner continue s to prescribe the drug to the
insured.
C. Modification prohibited under this section shall include,
but not be limited to :
1. Increasing the premium, copayment, coinsurance, or
deductible;
2. Denying or otherwise failing to provide continued coverage
of the prescription drug ;
3. Moving the drug to a more restrictive coverage categ ory or
tier; or
4. Replacing the brand-name drug for a generic drug after the
insured has qualified for the brand-name drug pursuant to this
section.
D. Nothing in this secti on shall be construed to prohibit an
insurer from modifying coverage of a prescription drug if:
1. The federal Food and Drug Administration has issued a
statement calling into question the clinical safety of the drug; or
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2. The manufacturer of the drug has notif ied the federal Food
and Drug Administration of a manufacturing discontinu ance or
potential discontinuance of the drug, as required by 21 U.S. C. 356c.
E. Any insurer that violates the provisions of this sect ion
shall be subject to a civil penalty in an amount to be determined by
the Insurance Commissioner . The Insurance Commissioner shall
promulgate rules to effectuate the provisions of this section.
SECTION 2. This act shall become effective November 1, 2023.
59-1-1218 RD 1/4/2023 3:37:21 PM