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STATE OF OKLAHOMA
1st Session of the 59th Legislature (2023)
SENATE BILL 146 By: Hicks
AS INTRODUCED
An Act relating to prescription drugs; creatin g the
Access to Lifesaving Medicines Act ; providing short
title; defining terms; prohibiting certain insurers
and pharmacy benefits managers from imposing cer tain
costs; requiring certain rebates be offered to
certain health benefit plans; establishing terms of
prescription drug cost sharing; directing
promulgation of rules; providing for noncodi fication;
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 not to be
codified in the Oklahoma Statutes reads as fo llows:
This act shall be known and may be cited as the “Access to
Lifesaving Medicines Act”.
SECTION 2. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Secti on 6971 of Title 36, unless there
is created a duplication in numbering, reads as follows:
A. As used in this section:
1. “Adjusted out-of-pocket amount” means the co-payment, co-
insurance, or other cost sharing obligation that a health benefit
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plan requires an insured to pay at the point -of-sale for a covered
prescription medication otherwise payable, less the pro rata portion
of any discounts, rebates, and price concessions in conn ection with
the prescription drug;
2. “Claim” means any bill, claim, or proof of loss made by or
on behalf of an insured or a provider, to a health insurer or its
intermediary, administrator, or representative, with which the
provider has a provider contract for payment for health care
services under any health benefit plan;
3. “Excess cost burden” means any co-payments, co-insurance, or
other cost sharing an insured is required to pay at the point-of-
sale to receive a prescription drug or de vice, that exceeds the
health insurer’s or pharmacy benefits manager ’s net cost after
applying a pro rata portion of any discounts, rebates, or
concessions received from manufacturers, pharmacies, or other third
parties;
4. “Health benefit plan” means a health benefit plan as defined
pursuant to Section 6060.4 of Title 36 of the Oklahoma S tatutes;
5. “Health care provider ” or “provider” means a health care
provider as defined purs uant to Section 3090.2 of Title 63 o f the
Oklahoma Statutes;
6. “Health insurer” means any entity subject to the
jurisdiction of the Insurance Department and the insurance laws and
regulations of this state that contracts or offers to contract to
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provide, deliver, arrange for , pay for, or reimburse any of the
costs of health care services , including but not limited to a health
maintenance organization, a health be nefit plan, or any other entit y
providing a plan of health insurance, health benefits, or health
care services;
7. “Maximum allowable claim ” means the amount the health
insurer or pharmacy benefits manager has agreed to pay a pharmacy;
8. “Maximum allowable cost” means the maximum dollar amount
that a health insurer or its intermediary will reimburse a pharmacy
provider for a group of drugs rated as “A”, “AB”, “NR”, or “NA” in
the most recent edition of the Approved Drug Products with
Therapeutic Evaluations, published by the United States Food and
Drug Administration, or similarly rated by a nationally recognized
reference;
9. “Pharmacy” means a pharmacy as defined pursuant to Section
353.1 of Title 59 of the Oklahoma Statutes;
10. “Pharmacy benefits ma nager” means a pharmacy benefits
manager as defined pursuant to Section 6960 of Titl e 36 of the
Oklahoma Statutes;
11. “Point-of-sale” means the transaction in which goods or
services, including but not limited to prescription medications,
medical devices, and medical supplies, are sold to the consumer;
12. “Rebate” means:
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a. negotiated price concessions , including but not
limited to base rebates and reasonable estimates of
any price protection rebates and performance-based
rebates that may accrue, directly or indirectly, to
the health insurer or pharmacy benefits manager as a
result of point-of-sale prescription medication claims
processing during the coverage year from a
manufacturer, dispensing pharmacy, or other party to
the transaction, or
b. reasonable estimates of any fees and other
administrative costs that are passed through to the
health insurer as a re sult of point-of-sale
prescription medication claims processing and serve to
reduce the health insurer ’s prescription medication
liabilities for the coverage year; and
13. “Provider contract” means any contract between a health
care provider and a health insurer , or an insurer’s network,
provider panel, intermediary, or represe ntative, relating to the
provision of health care services.
B. Any health insurer or pharmacy benefits manager that issues,
renews, or amends a health benefit plan with prescription drug
coverage shall not impose an excess cost burden on an insured.
C. When contracting with a health insurer or health benefit
plan to administer pharmacy benefits, a pharmacy benefits manager
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shall offer the health benefit plan the option of extending point-
of-sale rebates to enrollees of the plan.
D. Prescription drug cost sharing for an insured shall be the
lesser of:
1. The applicable co -payment for the prescription medication
that would be payable in the absence of this section;
2. The maximum allowable cost;
3. The maximum allowable claim;
4. The adjusted out-of-pocket amount as determined pursuant to
this section;
5. The amount an insured would pay for the prescr iption
medication if the insured purchased it without using his or her
health benefit plan or any other source of prescription medication
benefits or discounts; or
6. The amount the pharmacy will be reimbursed for the
prescription medication by the health insurer or p harmacy benefits
manager.
E. The Insurance Commissioner s hall promulgate rules to
effectuate the provisions of this section.
SECTION 3. This act shall become effective November 1, 2023.
59-1-1219 RD 1/4/2023 3:38:24 PM