Old	New		Differences
1		-	An Act
2		-	ENROLLED HOUSE
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3	29		BILL NO. 1843 By: Kerbs, Davis, Newton,
4	30		Grego, Maynard, Burns,
5		-	Roberts and Talley of the
	31	+	Roberts, and Talley of the
6	32		House
7	33
8	34		and
9	35
10		-	McCortney, Bullard and
	36	+	McCortney, Bullard, and
11	37		Stephens of the Senate
12	38
13	39
14	40
15	41
16	42
17	43		An Act relating to pharmacy benefit managers ;
18	44		amending 36 O.S. 2021, Section 6962, as amended by
19	45		Section 2, Chapter 38, O.S.L. 20 22 (36 O.S. Supp.
20	46		2022, Section 6962), which relates to compliance
21	47		review; replacing Insurance Commissioner with
22	48		Attorney General; amending 36 O.S. 2021 , Section
23	49		6965, which relates to power to inves tigate;
24	50		replacing investigative authority with the Attor ney
25	51		General; amending 36 O.S. 2021, Section 6966.1, as
26	52		amended by Section 3, Chapter 38, O.S.L. 2022 (36
27	53		O.S. Supp. 2022, Section 6966.1), which relates to
28	54		violations, penalties, and hearings; replacing
29	55		enforcement authority with the Attorney General;
30	56		and providing an effective date.
31	57
32	58
33		-	~~SUBJECT: Pharmacy benefit managers~~
	59	+
34	60
35	61		BE IT ENACTED BY THE P EOPLE OF THE STATE OF OKLAHOMA:
36		-
37	62		SECTION 1. AMENDATORY 36 O.S. 2021, Section 6962, as
38	63		amended by Section 2, Chapter 38, O.S.L. 2 022 (36 O.S. Supp. 2022,
39	64		Section 6962), is amended to read as follows:
40		-
41	65		Section 6962. A. The Oklahoma Insurance Department Attorney
42	66		General shall review and approve retail pharmacy network access for
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43	93		all pharmacy benefits managers (PBMs) to ensure complia nce with
44	94		Section 6961 of this title.
45		-
46		-	B. A PBM, or an agent of a PBM, s hall not: ENR. H. B. NO. 1843 Page 2
47		-
	95	+	B. A PBM, or an agent of a PBM, s hall not:
48	96		1. Cause or knowingly pe rmit the use of advertisement,
49	97		promotion, solicitation, representation, proposal or offer that is
50	98		untrue, deceptive or misleading;
51		-
52	99		2. Charge a pharmacist or pharmacy a fee related to the
53	100		adjudication of a claim including without limitation a fee for:
54		-
55	101		a. the submission of a claim,
56		-
57	102		b. enrollment or participation in a retail pharmacy
58	103		network, or
59		-
60	104		c. the development or management of claims processing
61	105		services or claims payment services related to
62	106		participation in a retail pharmacy network;
63		-
64	107		3. Reimburse a pharmacy or pharmacist in the state an amount
65	108		less than the amount that the PBM reimburses a pharmacy owned by or
66	109		under common ownership with a PBM for pro viding the same covered
67	110		services. The reimbursement amount paid to the pharmacy shall be
68	111		equal to the reimbursement amount calculated on a per -unit basis
69	112		using the same generic product identifier or generic code num ber
70	113		paid to the PBM-owned or PBM-affiliated pharmacy;
71		-
72	114		4. Deny a provider the opportunity to participate in any
73	115		pharmacy network at preferred participation status if the provider
74	116		is willing to accept the terms and conditions that the PBM has
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75	143		established for other providers as a condition of pref erred network
76	144		participation status;
77		-
78	145		5. Deny, limit or terminate a provider's contract based on
79	146		employment status of a ny employee who has an active license to
80	147		dispense, despite probation status, with the State Board of
81	148		Pharmacy;
82		-
83	149		6. Retroactively deny or r educe reimbursement for a covered
84	150		service claim after returning a paid claim response as part of the
85	151		adjudication of the claim, unless:
86		-
87	152		a. the original claim was submitted fraudulently, or
88		-
89	153		b. to correct errors identi fied in an audit, so long as
90	154		the audit was conducted in compliance with Sections
91		-	356.2 and 356.3 of Title 59 of the Oklahoma Statutes; ENR. H. B. NO. 1843 Page 3
92		-
	155	+	356.2 and 356.3 of Title 59 of the Oklahoma Statutes;
93	156		7. Fail to make any pa yment due to a pharmacy or pharmacist for
94	157		covered services properly re ndered in the event a PBM te rminates a
95	158		provider from a pharmacy bene fits manager network;
96		-
97	159		8. Conduct or practice spread pricing, as defined in Section 1
98	160		of this act, in this state; or
99		-
100	161		9. Charge a pharmacist or pharmacy a fee related to
101	162		participation in a retail pharmacy network inc luding but not limited
102	163		to the following:
103		-
104	164		a. an application fee,
105		-
106	165		b. an enrollment or participation fee,
107		-
108	166		c. a credentialing or re-credentialing fee,
109	167
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110	193		d. a change of ownership fee, or
111		-
112	194		e. a fee for the development or management of claims
113	195		processing services or claims payment services .
114		-
115	196		C. The prohibitions under this section shall apply to contracts
116	197		between pharmacy benefits managers and providers for participation
117	198		in retail pharmacy networks.
118		-
119	199		1. A PBM contract shall:
120		-
121	200		a. not restrict, directly or indirectly, any pharmacy
122	201		that dispenses a presc ription drug from informing, or
123	202		penalize such pharmacy for informing, an indivi dual of
124	203		any differential between the individual's out-of-
125	204		pocket cost or coverage with respect to acquisition of
126	205		the drug and the amount an indivi dual would pay to
127	206		purchase the drug directly, and
128		-
129	207		b. ensure that any entity that provides pharmacy benefits
130	208		management services under a contract with any such
131	209		health plan or health insurance coverage does not,
132	210		with respect to such plan or coverage, restric t,
133	211		directly or indirectly, a ph armacy that dispenses a
134	212		prescription drug from informing, or penalize such
135	213		pharmacy for informing, a covered individual of any
136		-	differential between the individual 's out-of-pocket ~~ENR. H. B. NO. 1843 Page 4~~
	214	+	differential between the individual 's out-of-pocket
137	215		cost under the plan or coverage with respect t o
138	216		acquisition of the drug and t he amount an individual
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139	243		would pay for acquisition of the drug without using
140	244		any health plan or health insurance coverage.
141		-
142	245		2. A pharmacy benefits manager 's contract with a provider shall
143	246		not prohibit, restrict or limit disclosure of information to the
144	247		Insurance Commissioner Attorney General, law enforcement or state
145	248		and federal governmental officials investigating or examining a
146	249		complaint or conducting a review of a pharmacy benefits manager 's
147	250		compliance with the requirements under the Patient's Right to
148	251		Pharmacy Choice Act.
149		-
150	252		D. A pharmacy benefits manager shall:
151		-
152	253		1. Establish and maintain an elect ronic claim inquiry
153	254		processing system using the National Council for Prescription Drug
154	255		Programs' current standards to communica te information to pharmacies
155	256		submitting claim inquiries;
156		-
157	257		2. Fully disclose to insurers, self-funded employers, unions or
158	258		other PBM clients the existence of the re spective aggregate
159	259		prescription drug discounts, rebates received from drug
160	260		manufacturers and pharmacy audit recoupments;
161		-
162	261		3. Provide the Insurance Commissioner Attorney General,
163	262		insurers, self-funded employer plans an d unions unrestricted audi t
164	263		rights of and access to the respective PBM pharmaceutical
165	264		manufacturer and provider contracts, plan utilizati on data, plan
166	265		pricing data, pharmacy utilization data and pharmacy pricing data;
167	266
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168	292		4. Maintain, for no less than three (3) years, documentation of
169	293		all network development activities including but not limited to
170	294		contract negotiations and any denials to provi ders to join networks.
171	295		This documentation shall be made available to the Commissioner
172	296		Attorney General upon request;
173		-
174	297		5. Report to the Commissioner Attorney General, on a quarterly
175	298		basis for each health insurer payor, on the following information:
176		-
177	299		a. the aggregate amount of rebates received by the PBM,
178		-
179	300		b. the aggregate amount of rebates distributed to the
180	301		appropriate health in surer payor,
181		-	ENR. H. B. NO. 1843 Page 5
182	302		c. the aggregate amount of rebates passed on to the
183	303		enrollees of each health insurer payor at the point of
184	304		sale that reduced the applicable deductible,
185	305		copayment, coinsure or other cost sharing amount of
186	306		the enrollee,
187		-
188	307		d. the individual and agg regate amount paid by t he health
189	308		insurer payor to the P BM for pharmacy services
190	309		itemized by pharmacy, drug product and service
191	310		provided, and
192		-
193	311		e. the individual and aggreg ate amount a PBM paid a
194	312		provider for pharmacy services itemized by pharmacy,
195	313		drug product and service provide d.
196		-
197	314		SECTION 2. AMENDATORY 36 O.S. 2021, Section 6965, is
198	315		amended to read as follows:
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199	341
200	342		Section 6965. A. The Insurance Commissioner Attorney General
201	343		shall have power and authority to examine and investigat e the
202	344		affairs of every pharmacy benefi ts manager (PBM) engaged in pharmacy
203	345		benefits management in this state in order to determine whet her such
204	346		entity is in compliance with the Patient's Right to Pharmacy Choice
205	347		Act.
206		-
207	348		B. All PBM files and records shall be subject to examination by
208	349		the Insurance Commissioner Attorney General or by duly appointed
209	350		designees. The Insurance Commissioner Attorney General, authorized
210	351		employees and examiners shall have access to any of a PBM's files
211	352		and records that may relate to a particular complaint under
212	353		investigation or to an inquiry or examination by the Insurance
213	354		Department Attorney General.
214		-
215	355		C. Every officer, director, employee or agent of the PB M, upon
216	356		receipt of any inquiry from the Commissioner Attorney General shall,
217	357		within twenty (20) days from the date the inquiry is sent , furnish
218	358		the Commissioner Attorney General with an adequate response to the
219	359		inquiry.
220		-
221	360		D. When making an examination under this section, the Insurance
222	361		Commissioner Attorney General may retain subject matter experts,
223	362		attorneys, appraisers, independent actua ries, independent certified
224	363		public accountants or an accounting firm or individual holding a
225	364		permit to practice public acc ounting, certified financial examiners
226		-	or other professionals and specialists as examiners, the cost of ENR. H. B. NO. 1843 Page 6
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227	392		which shall be borne by the PB M that is the subject of the
228	393		examination.
229		-
230	394		SECTION 3. AMENDATORY 36 O.S. 2021, Section 6966.1, as
231	395		amended by Section 3, Chapter 38, O.S.L. 2022 (36 O.S. Supp. 2022,
232	396		Section 6966.1), is amende d to read as follows:
233		-
234	397		Section 6966.1 A. The Insurance Commissioner may censure,
235	398		suspend, revoke or refu se to issue or renew a license of or levy a
236	399		civil penalty against any person licensed under the insurance laws
237	400		of this state for any violation of the Patient's Right to Pharmacy
238	401		Choice Act, Section 6958 et seq. of Title 6 of the Oklahoma Statutes
239	402		this title.
240		-
241	403		B. 1. If the Commissioner Attorney General finds, after notice
242	404		and opportunity for hearing, that a pharmacy benefits manager (PBM)
243	405		violated one or more provisions of the Patient's Right to Pharmacy
244	406		Choice Act, the Pharmacy Audit Integrity Act or the p rovisions of
245	407		Sections 357 through 360 of Title 59 of the Oklahoma Statues, the
246	408		Attorney General may recommend the PBM may be censured, his or her
247	409		license may be suspended or rev oked and a penalty or remedy
248		-	authorized by this act may be imposed. If the Attorney General
249		-	makes such recommendation, the Commissioner shall take the
250		-	recommended action.
251		-
	410	+	authorized by this act may be imposed. If the Attorney General makes
	411	+	such recommendation, the Commissioner shall take the recommended
	412	+	action.
252	413		2. In addition to or in lieu of any censure, suspension or
253	414		revocation of a license, a PBM may be subject to a civil fine of n ot
254	415		less than One Hundred Dollars ($100.00) and not greater tha n Ten
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255	442		Thousand Dollars ($10,000.00) for each violation of the provisions
256	443		of the Patient's Right to Pharmacy Choice Act, the Pharmacy Audit
257	444		Integrity Act or the provis ions of Sections 357 through 360 of Title
258	445		59 of the Oklahoma Statues, following notice and an opportunity for
259	446		a hearing.
260		-
261	447		C. Notwithstanding whether the license of a PBM has been
262	448		issued, suspended, revoke d, surrendered or lapsed by operation of
263	449		law, the Commissioner Attorney General is hereby authorized to
264	450		enforce the provisions of the Patient 's Right to Pharmacy Cho ice Act
265	451		and impose any penalty or remedy authorized under the act against a
266	452		PBM under investigation for or charg ed with a violation of the
267	453		Patient's Right to Pharmacy Choi ce Act, the Pharmacy Audit Integrity
268	454		Act, the provisions of Se ctions 357 through 360 of Title 59 of the
269	455		Oklahoma Statues or any provision of the insurance laws of this
270	456		state.
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272	457		D. Each day that a P BM conducts business in this sta te without
273	458		a license from the Insurance Department shall be deemed a violation
274	459		of the Patient's Right to Pharmacy Choice Act.
275		-
276	460		E. 1. All hearings conducted by the Insurance Department
277	461		office of the Attorney General pursuant to this section shall be
278	462		public and held in accordance with the Administrative Procedures
279	463		Act.
280	464
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281	490		2. Hearings shall be held at the office of the Insurance
282	491		Commissioner Attorney General or any other place the Commissioner
283	492		Attorney General may deem convenient.
284		-
285	493		3. The Commissioner Attorney General, upon written reque st from
286	494		a PBM affected by the hearing, shall cause a full sten ographic
287	495		record of the proceedings to be made by a competent court reporter.
288	496		This record shall be at the expense of the PBM.
289		-
290	497		4. The ordinary fees and cost s of the hearing examiner
291	498		appointed pursuant to Section 319 of Title 36 of the Oklahoma
292	499		Statutes this title may be assessed by the he aring examiner against
293	500		the respondent unless the respondent is the prevailing party.
294		-
295	501		F. Any PBM whose license has been censured, susp ended, revoked
296	502		or denied renewal or who has had a fine levied against him or her
297	503		shall have the right of appeal from the f inal order of the Insurance
298	504		Commissioner Attorney General, pursuant to Section 318 et seq. of
299	505		Title 75 of the Oklahoma Statutes.
300		-
301	506		G. If the Insurance Commissioner Attorney General determines,
302	507		based upon an investigation of complaints, that a PBM has engage d in
303	508		violations of the provisions of the Patient's Right to Pharmacy
304	509		Choice Act with such frequency as to indicate a general business
305	510		practice, and that the PBM should be subjected to closer supervision
306	511		with respect to thos e practices, the Commissioner Attorney General
307	512		may require the PBM to file a report at any peri odic interval the
308	513		Commissioner Attorney General deems necessary.
309	514
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310	540		SECTION 4. This act shall become effective November 1, 2023.
311		-	ENR. H. B. NO. 1843 Page 8
312	541		Passed the House of Representatives the 21st day of March, 2023.
313	542
314	543
315	544
316	545
317	546		Presiding Officer of the House
318	547		of Representatives
319	548
320	549
321		-	Passed the Senate the ~~25th~~ day of ~~April~~, 2023.
	550	+	Passed the Senate the ____ day of __________, 2023.
322	551
323	552
324	553
325	554
326	555		Presiding Officer of the Senate
327	556
328	557
329		-	OFFICE OF THE GOVERNOR
330		-	Received by the Office of the Governor this ____________________
331		-	day of ___________________, 20_______, at _______ o'clock _______ M.
332		-	By: _________________________________
333		-	Approved by the Governor of the State of Oklahoma this _________
334		-	day of ___________________, 20_______, at _______ o'clock _______ M.
335		-
336		-
337		-	_________________________________
338		-	Governor of the State of Oklahoma
339		-
340		-	OFFICE OF THE SECRETARY OF STATE
341		-	Received by the Office of the Secretary of State this __________
342		-	day of ___________________, 20_______, at _______ o'clock _______ M.
343		-	By: _________________________________
344		-

Oklahoma 2024 Regular Session

Oklahoma House Bill HB1843 Compare Versions