Oklahoma 2024 Regular Session

Oklahoma House Bill HB2853 Compare Versions

Version 1 (Old)

Version 2 (New)

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	3	+	ENGR. H. B. NO. 2853 Page 1 1
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29		-	SENATE FLOOR VERSION
30		-	April 11, 2023
31		-
32		-
33	28		ENGROSSED HOUSE
34	29		BILL NO. 2853 By: Wallace and Caldwell (Chad)
35	30		of the House
36	31
37	32		and
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39		-	Montgomery, Rogers, Hicks,
40		-	Kirt, Kidd, Murdock,
41		-	Stanley, Standridge, a nd
42		-	Garvin of the Senate
43		-
	34	+	Montgomery of the Senate
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47	38		An Act relating to health care; creating the Oklahoma
48	39		Rebate Pass-Through and PBM Meaningful Transparency
49	40		Act of 2023; amending 59 O.S. 2021, Sections 357 and
50	41		358, which relate to definitions; modifying
51	42		definitions, procedures, and penalties; creating
52	43		duties; creating licensing application requirements;
53	44		amending 36 O.S. 2021, Section 6960, as amended by
54	45		Section 1, Chapter 38, O.S.L. 20 22 (36 O.S. Supp.
55	46		2022, Section 6960), which relates to definitions;
56	47		defining terms; creating PBM disclosures; amending 36
57	48		O.S. 2021, Section 6962, as amended by Section 2,
58	49		Chapter 38, O.S.L. 2022 (36 O.S. Supp. 2022, Section
59	50		6962), which relates to pharma cy benefits manager
60	51		compliance; creating duties; amending 36 O.S. 2021,
61	52		Section 6964, which relates to a formulary for
62	53		prescription drugs; creating agency duties; providing
63	54		cost sharing calculation methodo logy, limitations,
64	55		and requirements; creating penalties; clarifying
65	56		authority to take certain actions; prohibiting the
66	57		disclosure of certain informat ion; declaring that
67	58		certain information not be considere d public record;
68	59		providing for noncodification; providing for
69	60		codification; and providing an effecti ve date.
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	64	+	BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
	65	+	SECTION 1. NEW LAW A new section of law not to be
	66	+	codified in the Oklahoma Statutes reads as follows:
	67	+	This act shall be known and may be cited as the "Oklahoma Rebate
	68	+	Pass-Through and PBM Meaningful Transparency Act of 2023".
73	69
74		-
75		-	BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
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	70	+	ENGR. H. B. NO. 2853 Page 2 1
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103		-	SECTION 1. NEW LAW A new section of law not to be
104		-	codified in the Oklahoma Statutes reads as follows:
105		-	This act shall be known and may be cited as the "Oklahoma Rebate
106		-	Pass-Through and PBM Meaningful Transparency Act of 2023".
107	95		SECTION 2. AMENDATORY 59 O.S. 2021, Section 357, is
108	96		amended to read as follows:
109	97		Section 357. As used in this act:
110	98		1. "Covered entity" means a nonprofit hospital or medical
111	99		service organization, insurer, health coverage plan or health
112	100		maintenance organization; a health program administered by the state
113	101		in the capacity of pro vider of health coverage; or an employer,
114	102		labor union, or other entity organized in the state that provides
115	103		health coverage to covered individuals who are employed or reside in
116	104		the state. This term does not include a health pla n that provides
117	105		coverage only for accidental injury, specified diseas e, hospital
118	106		indemnity, disability income, or other li mited benefit health
119	107		insurance policies and contracts that do not include prescription
120	108		drug coverage;
121	109		2. "Covered individual" means a member, participant, enroll ee,
122	110		contract holder or policy holder or b eneficiary of a covered entity
123	111		who is provided health coverage by the covered entity. A covered
124	112		individual includes any dependent or other person pr ovided health
125	113		coverage through a polic y, contract or plan for a co vered
126	114		individual;
	115	+	3. "Department" means the Oklahoma Insurance Department;
	116	+	4. "Maximum allowable cost" or "MAC" means the list of drug
	117	+	products delineating the maximum per -unit reimbursement for
	118	+	multiple-source prescription dr ugs, medical product or devi ce;
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	120	+	ENGR. H. B. NO. 2853 Page 3 1
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154		-	3. "Department" means the Oklahoma Insurance Department;
155		-	4. "Maximum allowable cost" or "MAC" means the list of drug
156		-	products delineating the maximum per -unit reimbursement for
157		-	multiple-source prescription dr ugs, medical product or device;
158	145		5. "Multisource drug product reimbur sement" (reimbursement)
159	146		means the total amount paid t o a pharmacy inclusive of any reduction
160	147		in payment to the pharmacy, excluding prescription dispe nse fees;
161	148		6. "Pharmacy benefits manag ement" means a service provi ded to
162	149		covered entities to facilitate the provision of prescription drug
163	150		benefits to covered i ndividuals within the state, including
164	151		negotiating pricing and other terms with drug manufacture rs and
165	152		providers. Pharmacy benefits m anagement may include any or all of
166	153		the following services:
167	154		a. claims processing, performance of drug utilization
168	155		review, processing of drug prior authorization
169	156		requests, retail network management and payment of
170	157		claims to pharmacies for prescription drugs dispensed
171	158		to covered individuals,
172	159		b. clinical formulary development a nd management
173	160		services,
174	161		c. rebate contracting an d administration,
175	162		d. certain patient compliance, therapeutic intervention
176	163		and generic substitution pr ograms, or
177	164		e. disease management progr ams,
	165	+	f. adjudication of appeals and grievances related to the
	166	+	prescription drug benefit, or
	167	+	g. controlling the cost of pre scription drugs;
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205		-	f. adjudication of appeals and grievances related to the
206		-	prescription drug benefit, or
207		-	g. controlling the cost of pre scription drugs;
208	194		7. "Pharmacy benefits manager" or "PBM" means a person,
209	195		business or other enti ty that, either directly or through an
210	196		intermediary, performs pharmacy benefit s management. The term
211	197		includes a person or entity acting for a PBM in a contract ual or
212	198		employment relationship in the performance of pharmacy benefits
213	199		management for a managed care company, nonprofit hospital, medi cal
214	200		service organization, insurance comp any, third-party payor, or a
215	201		health program administered by an agency of this stat e. PBM does
216	202		not include a Pharmacy Services Administrative Organization ;
217	203		8. "Plan sponsor" means the employers, insurance companies,
218	204		unions and health maintenance organizations or any other entity
219	205		responsible for establishing, maintaining, or administering a health
220	206		benefit plan on behalf of covered individuals; and
221	207		9. "Provider" means a pharmacy licensed by the State Board of
222	208		Pharmacy, or an agent or representative of a pharmacy, including,
223	209		but not limited to, the pharmacy's contracting agent, which
224	210		dispenses prescription drugs or devices to covered individuals.
225	211		SECTION 3. AMENDATORY 59 O.S. 2021, Section 358, is
226	212		amended to read as follows:
227	213		Section 358. A. In order to provide pharmacy benefits
228	214		management or any of the services included under the definition of
	215	+	pharmacy benefits management in this state, a pharmac y benefits
	216	+	manager or any entity acting as one in a contractual or employment
	217	+	relationship for a covered entity sha ll first obtain a license from
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256		-	pharmacy benefits management in this state, a pharmac y benefits
257		-	manager or any entity acting as one in a contractual or employment
258		-	relationship for a covered entity sha ll first obtain a license from
259	244		the Oklahoma Insurance D epartment, and the Department may charge a
260	245		fee for such licensure.
261	246		B. The Department shall establish, by regulation, licensure
262	247		procedures, required disclosures for pharmacy benefits managers
263	248		(PBMs) and other rules as may be necessary for carrying out and
264	249		enforcing the provisions of this act. The licensure procedures
265	250		shall, at a minimum, i nclude the completion of an application form
266	251		that shall include the name and address of an agent for service of
267	252		process, the payment of a requisite fee, and evidence of t he
268	253		procurement of a surety bond the following:
269	254		1. The name, address, and telephone contact number of the PBM;
270	255		2. The name and address of the PBM's agent for service of
271	256		process in the state;
272	257		3. The name and address of each person with management or
273	258		control over the PBM;
274	259		4. Evidence of the procurement of a surety bon d;
275	260		5. The name and address of each person with a beneficial
276	261		ownership interest in the PBMs;
277	262		6. In the case of a PBM applicant that is a partnership or
278	263		other unincorporated association, limited liability corporation, or
	264	+	corporation, and has five or more partners, members, or
	265	+	stockholders:
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306		-	corporation, and has five or more partners, members, or
307		-	stockholders:
308	292		a. the applicant shall specify its legal structure and
309	293		the total number of partners, members, or
310	294		stockholders,
311	295		b. the applicant shall specify the name, address, usual
312	296		occupation, and professional qualifications of the
313	297		five partners, members , or stockholders with the five
314	298		largest ownership interests in the PBM, and
315	299		c. the applicant shall agree that, upon request by the
316	300		Department, it shall furnish the Department with
317	301		information regarding the name, address, usual
318	302		occupation, and professional qualifications of any
319	303		other partners, members, or stockholders;
320	304		7. A signed statement indicating that the PBM has not been
321	305		convicted of a felony and has not violated any of the requirements
322	306		of the Oklahoma Pharmacy Act and the Patient 's Right to Pharmacy
323	307		Choice Act, or, if the applicant cannot provide such a statement, a
324	308		signed statement describing all relevant convictions or violations;
325	309		and
326	310		8. Any other information the Com missioner deems necessary to
327	311		review.
328	312		C. The Department may subpoena witnesses and informa tion. Its
329	313		compliance officers may take and copy records for investigative use
	314	+	and prosecutions. Nothing in this subsection shall limit the Office
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357		-	and prosecutions. Nothing in this subsection shall limit the Office
358	341		of the Attorney General from using its investigative demand
359	342		authority to investigate and prosecute violation s of the law.
360	343		D. The Department may suspend , revoke or refuse to issue or
361	344		renew a license for noncompliance wi th any of the provisions hereby
362	345		established or with the rules promulgated by the Department; for
363	346		conduct likely to mislead, deceive or defraud th e public or the
364	347		Department; for unfair or de ceptive business practices or for
365	348		nonpayment of a renewal fee or fi ne. The Department may also levy
366	349		administrative fines for each count of which a PBM has been
367	350		convicted in a Department hearing.
368	351		SECTION 4. AMENDATORY 36 O.S. 2021 , Section 6960, as
369	352		amended by Section 1, Chapter 38, O.S.L. 2022 (3 6 O.S. Supp. 2022,
370	353		Section 6960), is amended to read as follows:
371	354		Section 6960. For purposes of the Patient 's Right to Pharmacy
372	355		Choice Act:
373	356		1. "Administrative fees" means fees or payments from
374	357		pharmaceutical manufacturers to, or otherwise retained by, a
375	358		pharmacy benefits manager (PBM) or its designee pursuant to a
376	359		contract between a PBM or affiliate and the manufacturer in
377	360		connection with the PBM's administering, invoicing, alloc ating, and
378	361		collecting the rebates;
379	362		2. "Aggregate retained rebate percentage" means the percentage
380	363		of all rebates received by a PBM from all pharmaceutical
	364	+	manufacturers which is not passed on t o the PBM's health plan or
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408		-	manufacturers which is not passed on t o the PBM's health plan or
409	391		health insurer clients. Aggregate retained rebate percentage shall
410	392		be expressed without disclosing any identifyi ng information
411	393		regarding any health plan, prescription drug, or therapeutic class,
412	394		and shall be calculated by dividi ng:
413	395		a. the aggregate dollar amount of all rebates that the
414	396		PBM received during the prior calendar year from al l
415	397		pharmaceutical manufacturers and did not pass through
416	398		to the PBM's health plan or health insurer clients, by
417	399		b. the aggregate dollar amount of all rebates that the
418	400		pharmacy benefits manager received duri ng the prior
419	401		calendar year from all pharmaceutical manufacturers;
420	402		3. "Defined cost sharing" means a deductible payment or
421	403		coinsurance amount imposed on an enrollee for a cover ed prescription
422	404		drug under the enrollee's health plan;
423	405		4. "Formulary" means a list of prescription drugs, as well as
424	406		accompanying tiering and other coverage inf ormation, that has been
425	407		developed by an issuer, a health plan, or the designee of a health
426	408		insurer or health plan, which the health insurer, health pla n, or
427	409		designee of the health insurer or health plan references in
428	410		determining applicable coverage and ben efit levels;
429	411		5. "Generic equivalent" means a drug that is designated to be
430	412		therapeutically equivalent, as indicated by the United States Food
431	413		and Drug Administration's "Approved Drug Products with Therapeutic
	414	+	Equivalence Evaluations"; provided, however, t hat a drug shall not
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459		-	Equivalence Evaluations"; provided, however, t hat a drug shall not
460	441		be considered a generic equivalent until the drug becomes nationally
461	442		available;
462	443		6. "Health insurer" means any corporation, associ ation, benefit
463	444		society, exchange, partnership or individual subject to state law
464	445		requires insurance and licensed by under the Oklahoma Insurance
465	446		Code;
466	447		7. "Health insurer administrative service fees" means fees or
467	448		payments from a health insurer or a designee of the health insurer
468	449		to, or otherwise retained by, a PBM or its designee pursuant to a
469	450		contract between a PBM or affiliate, and the health insurer or
470	451		designee of the health insurer in connection with the PBM managing
471	452		or administering the pharmacy benefit and administering, invoicing,
472	453		allocating, and collecting rebates;
473	454		2. 8. "Health insurer payor" means a health insurance company,
474	455		health maintenance organization, union, hospital and medical
475	456		services organization or any entity providing or admin istering a
476	457		self-funded health benefit plan;
477	458		9. "Health plan" means a policy, contract, certification, or
478	459		agreement offered or issued by a health insurer to provide, deliver,
479	460		arrange for, pay for, or reimburse any of the costs of health
480	461		services;
	462	+	3. 10. "Mail-order pharmacy" means a pharmacy licensed by this
	463	+	state that primarily dispenses and delivers covered drugs via common
	464	+	carrier;
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508		-	3. 10. "Mail-order pharmacy" means a pharmacy licensed by this
509		-	state that primarily dispenses and delivers covered drugs via common
510		-	carrier;
511	491		4. 11. "Pharmacy benefits manager" or "PBM" means a person
512	492		that, either directly or t hrough an intermediary, performs pharmacy
513	493		benefits management, as defined in paragra ph 6 of Section 357 of
514	494		Title 59 of the Oklahoma Statutes, and any other person acting for
515	495		such person under a contractual or employment relationship in the
516	496		performance of pharmacy benefits management for a managed -care
517	497		company, nonprofit hospital, medical service organization, insurance
518	498		company, third-party payor or a health program administered by a
519	499		department of this state. PBM does not include a Pharmacy Services
520	500		Administrative Organiz ation;
521	501		12. "Pharmacy and therapeutics committee" or "P&T committee"
522	502		means a committee at a hospital or a health insurance plan that
523	503		decides which drugs will appear on that entity's drug formulary;
524	504		13. "Price protection rebate" means a negotiated price
525	505		concession that accrues directly or indirectly to the health
526	506		insurer, or other party on behalf of the health insurer, in the
527	507		event of an increase in the wholesale acquisition of a drug above a
528	508		specified threshold;
529	509		5. 14. "Provider" means a pharmacy, as defined in Section 353.1
530	510		of Title 59 of the Oklahoma Statutes or an agent or representative
531	511		of a pharmacy;
	512	+	15. "Rebates" means:
	513	+	a. negotiated price concessions including, but not
	514	+	limited to, base price concessions (whether described
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559		-	15. "Rebates" means:
560		-	a. negotiated price concessions including, but not
561		-	limited to, base price concessions (whether described
562	541		as a rebate or otherwise) and reasonable estima tes of
563	542		any price protection rebates and performa nce-based
564	543		price concessions that may accrue d irectly or
565	544		indirectly to a health insurer, health plan, or PBM
566	545		during the coverage year from a manufacturer,
567	546		dispensing pharmacy, or other party in connection with
568	547		the dispensing or administration of a prescription
569	548		drug, and
570	549		b. reasonable estimates of any price concessions, fees ,
571	550		and other administrative costs that are passed
572	551		through, or are reasonably anticipated to be passed
573	552		through, to a health insurer, health plan, or PBM and
574	553		serve to reduce the health insurer, health plan, or
575	554		PBM's liabilities for a pr escription drug;
576	555		6. 16. "Retail pharmacy network" means retail pharmacy
577	556		providers contracted with a PBM in which the pharmacy primari ly
578	557		fills and sells prescriptions via a retail, storefront location;
579	558		7. 17. "Rural service area" means a five-digit ZIP code in
580	559		which the population density is less than one thousand (1,000)
581	560		individuals per square mile;
	561	+	8. 18. "Spread pricing" means a prescription drug pricing model
	562	+	utilized by a pharmacy benefits manager in which the PBM charges a
	563	+	health benefit plan a contracted price for prescri ption drugs that
582	564
583		-	SENATE FLOOR VERSION - HB2853 SFLR Page 12
584		-	(Bold face denotes Committee Amendments) 1
	565	+	ENGR. H. B. NO. 2853 Page 12 1
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608	589
609		-	8. 18. "Spread pricing" means a prescription drug pricing model
610		-	utilized by a pharmacy benefits manager in which the PBM charges a
611		-	health benefit plan a contracted price for prescri ption drugs that
612	590		differs from the amount the PBM directly or indirectly pays the
613	591		pharmacy or pharmacist for pr oviding pharmacy services;
614	592		9. 19. "Suburban service area" means a five-digit ZIP code in
615	593		which the population density is between one thousand (1, 000) and
616	594		three thousand (3,000) individuals per square mile; and
617	595		10. 20. "Urban service area" means a five-digit ZIP code in
618	596		which the population density is greater than three thous and (3,000)
619	597		individuals per square mile.
620	598		SECTION 5. AMENDATORY 36 O.S. 2021, Section 6962, as
621	599		amended by Section 2, Chapter 38, O.S.L. 2022 (36 O.S. Supp. 2022,
622	600		Section 6962), is am ended to read as follows:
623	601		Section 6962. A. The Oklahoma Insurance Department shall
624	602		review and approve retail pharmacy net work access for all pharmacy
625	603		benefits managers (PBMs) to ensure compliance with Section 6961 of
626	604		this title.
627	605		B. A PBM, or an agent of a PBM, shall not:
628	606		1. Cause or knowingly pe rmit the use of advertisement,
629	607		promotion, solicitation, representation, proposa l or offer that is
630	608		untrue, deceptive or misleading;
631	609		2. Charge a pharmacist or pharmacy a fee related to the
632	610		adjudication of a claim including without limitation a fee for:
	611	+	a. the submission of a claim,
	612	+	b. enrollment or participation in a retail pharmacy
	613	+	network, or
633	614
634		-	SENATE FLOOR VERSION - HB2853 SFLR Page 13
635		-	(Bold face denotes Committee Amendments) 1
	615	+	ENGR. H. B. NO. 2853 Page 13 1
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660		-	a. the submission of a claim,
661		-	b. enrollment or participation in a retail pharmacy
662		-	network, or
663	640		c. the development or management of claims processing
664	641		services or claims payment services related to
665	642		participation in a retail pharmacy network;
666	643		3. Reimburse a pharmacy or pharmacist in the state an amount
667	644		less than the amount that the PBM reim burses a pharmacy owned by or
668	645		under common ownership with a PBM for providing the same covered
669	646		services. The reimbursement amount paid to the pharmacy shall be
670	647		equal to the reimbursement amount calculated on a per -unit basis
671	648		using the same generic product identifier or generic code number
672	649		paid to the PBM-owned or PBM-affiliated pharmacy;
673	650		4. Deny a provider the opportunity to participate in any
674	651		pharmacy network at preferred participation status if the provider
675	652		is willing to accept the terms and conditions that the PBM has
676	653		established for other providers as a condition of preferred network
677	654		participation status;
678	655		5. Deny, limit or terminate a provider's contract based on
679	656		employment status of any employee who has an active license to
680	657		dispense, despite probatio n status, with the State Board of
681	658		Pharmacy;
	659	+	6. Retroactively deny or reduce reimbursement for a covered
	660	+	service claim after returning a paid claim response as part of the
	661	+	adjudication of the claim, unless:
	662	+	a. the original claim was submitted fraudulently, or
682	663
683		-	SENATE FLOOR VERSION - HB2853 SFLR Page 14
684		-	(Bold face denotes Committee Amendments) 1
	664	+	ENGR. H. B. NO. 2853 Page 14 1
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709		-	6. Retroactively deny or reduce reimbursement for a covered
710		-	service claim after returning a paid claim response as part of the
711		-	adjudication of the claim, unless:
712		-	a. the original claim was submitted fraudulently, or
713	689		b. to correct errors identified in an audit, so long as
714	690		the audit was conducted in compliance with Sections
715	691		356.2 and 356.3 of Title 59 of the Oklahoma Statutes;
716	692		7. Fail to make any payment due to a pharmacy or pharmacist for
717	693		covered services properly rendered in the event a PBM terminates a
718	694		provider from a pharmacy benefits manager network ;
719	695		8. Conduct or practice Either directly or through an
720	696		intermediary, agent, or affiliate, engag e in, facilitate, or enter
721	697		into a contract with another person involv ing spread pricing, as
722	698		defined in Section 1 6960 of this act title, in this state; or
723	699		9. Charge a pharmacist or pharmacy a fee related to
724	700		participation in a retail pharmacy network inclu ding but not limited
725	701		to the following:
726	702		a. an application fee,
727	703		b. an enrollment or participation fee,
728	704		c. a credentialing or re-credentialing fee,
729	705		d. a change of ownership fee , or
730	706		e. a fee for the development or manageme nt of claims
731	707		processing services or cl aims payment services ; or
732	708		10. Prohibit or penalize a pharmacy or pha rmacist for:
	709	+	a. disclosing to an individual information regarding the
	710	+	existence and clinical efficacy of a generic
	711	+	equivalent that would be less expe nsive to the
	712	+	enrollee:
733	713
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735		-	(Bold face denotes Committee Amendments) 1
	714	+	ENGR. H. B. NO. 2853 Page 15 1
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760		-	a. disclosing to an individual information regarding the
761		-	existence and clinical efficacy of a generic
762		-	equivalent that would be less expe nsive to the
763		-	enrollee:
764	739		(1) under his or her health plan prescription drug
765	740		benefit, or
766	741		(2) outside his or her health plan prescription drug
767	742		benefit, without requesting any health plan
768	743		reimbursement, than the drug that was orig inally
769	744		prescribed, or
770	745		b. selling to an individual, instead of a parti cular
771	746		prescribed drug, a therapeutically equivalent drug
772	747		that would be less expensive to the enrollee:
773	748		(1) under his or her health plan prescription drug
774	749		benefit, or
775	750		(2) outside his or her health plan prescription drug
776	751		benefit, without requesting any healt h plan
777	752		reimbursement, than the drug that was originally
778	753		prescribed.
779	754		C. The prohibitions under this section shall apply to contracts
780	755		between pharmacy benefits managers and providers for participation
781	756		in retail pharmacy networks.
782	757		1. A PBM contract shall:
	758	+	a. not restrict, directly or indirectly, any pharmacy
	759	+	that dispenses a prescription drug from informing, or
	760	+	penalize such pharmacy for informing, an individual of
	761	+	any differential between the individual's out-of-
	762	+	pocket cost or coverage with respect to acqui sition of
783	763
784		-	SENATE FLOOR VERSION - HB2853 SFLR Page 16
785		-	(Bold face denotes Committee Amendments) 1
	764	+	ENGR. H. B. NO. 2853 Page 16 1
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809	788
810		-	a. not restrict, directly or indirectly, any pharmacy
811		-	that dispenses a prescription drug from informing, or
812		-	penalize such pharmacy for informing, an individual of
813		-	any differential between the individual's out-of-
814		-	pocket cost or coverage with respect to acqui sition of
815	789		the drug and the amount an individual would pay to
816	790		purchase the drug directly, and
817	791		b. ensure that any entity that provides pharmacy benefits
818	792		management services under a contract with any such
819	793		health plan or health insurance coverage does not,
820	794		with respect to such plan or coverage, restrict,
821	795		directly or indirectly, a pharmacy that dispenses a
822	796		prescription drug from informing, or penalize such
823	797		pharmacy for informing, a covered individual of any
824	798		differential between the individual's out-of-pocket
825	799		cost under the plan or coverage with respect to
826	800		acquisition of the drug and the amount an individual
827	801		would pay for acquisition of the drug without using
828	802		any health plan or health insurance coverage.
829	803		2. A pharmacy benefit s manager's contract with a provider shall
830	804		not prohibit, restrict or limit disclosure of information to the
831	805		Insurance Commissioner, law enforcement or state and federal
832	806		governmental officials investigating or examining a complaint or
	807	+	conducting a review of a pharmacy benefits manager 's compliance with
	808	+	the requirements under the Patient's Right to Pharmacy Choice Act.
	809	+	D. A pharmacy benefits manager shall:
	810	+	1. Establish and maintain an electronic claim inquiry
	811	+	processing system using the National Council for Prescription Drug
833	812
834		-	SENATE FLOOR VERSION - HB2853 SFLR Page 17
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	813	+	ENGR. H. B. NO. 2853 Page 17 1
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859	837
860		-	conducting a review of a pharmacy benefits manager 's compliance with
861		-	the requirements under the Patient's Right to Pharmacy Choice Act.
862		-	D. A pharmacy benefits manager shall:
863		-	1. Establish and maintain an electronic claim inquiry
864		-	processing system using the National Council for Prescription Drug
865	838		Programs' current standards to communica te information to pharmacies
866	839		submitting claim inquiries;
867	840		2. Fully disclose to insurers, self-funded employers, unions or
868	841		other PBM clients the existence of the respective aggregate
869	842		prescription drug discounts, rebates received from dr ug
870	843		manufacturers and pharmacy audit recoupments;
871	844		3. Provide the Insu rance Commissioner, insurers, self-funded
872	845		employer plans and unions unrestricted audit rights of and access to
873	846		the respective PBM pharmaceutical manu facturer and provider
874	847		contracts, plan utilization data, plan pricing data, pharmacy
875	848		utilization data and ph armacy pricing data;
876	849		4. Maintain, for no less than three (3) years, documentation of
877	850		all network development activities including but not limited to
878	851		contract negotiations and any denials to providers to join networks.
879	852		This documentation shall be made ava ilable to the Commissioner upon
880	853		request;
881	854		5. Report to the Commissioner, on a quarterly basis in a manner
882	855		and form prescribed by the Commissioner , along with any applicable
883	856		fees set by the Commissioner, a report on the first day of each
	857	+	calendar year, containing aggregate information for the prior
	858	+	calendar year. The report shall include the following information
	859	+	as it pertains to the PB M's contracts with insurers in the state,
	860	+	broken out for each health insurer payor, on the following
	861	+	information:
884	862
885		-	SENATE FLOOR VERSION - HB2853 SFLR Page 18
886		-	(Bold face denotes Committee Amendments) 1
	863	+	ENGR. H. B. NO. 2853 Page 18 1
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910	887
911		-	calendar year, containing aggregate information for the prior
912		-	calendar year. The report shall include the following information
913		-	as it pertains to the PB M's contracts with insurers in the state,
914		-	broken out for each health insurer payor, on the following
915		-	information:
916	888		a. the aggregate amount of rebates received by the PBM
917	889		received from all pharmaceutical manufacturers ,
918	890		b. the aggregate amount of rebates distributed to the
919	891		appropriate health insurer payor,
920	892		c. the aggregate amount of rebates that the PBM received
921	893		from all pharmaceutical manufacturers and did not pass
922	894		through to health insurers,
923	895		d. the aggregate amount of rebates passed on to the
924	896		enrollees of each health insur er payor at the point of
925	897		sale that reduced the applicable deductible,
926	898		copayment, coinsure or other defined cost sharing
927	899		amount of the enrollee,
928	900		d.
929	901		e. the aggregate amount of all administrative fees the
930	902		PBM received,
931	903		f. the aggregate amount of health insurer administrative
932	904		service fees that the PBM received,
	905	+	g. the aggregate amount of all administrative fees tha t
	906	+	the PBM received from all pharmaceutical manufacturers
	907	+	and did not pass through to health insurers,
	908	+	h. the aggregate retained rebate perc entage, across all
	909	+	the PBM's contractual or othe r relationships with all
	910	+	health insurers, the highest aggregate re tained rebate
	911	+	percentage, the lowest aggregate retained rebate
933	912
934		-	SENATE FLOOR VERSION - HB2853 SFLR Page 19
935		-	(Bold face denotes Committee Amendments) 1
	913	+	ENGR. H. B. NO. 2853 Page 19 1
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959	937
960		-	g. the aggregate amount of all administrative fees tha t
961		-	the PBM received from all pharmaceutical manufacturers
962		-	and did not pass through to health insurers,
963		-	h. the aggregate retained rebate perc entage, across all
964		-	the PBM's contractual or othe r relationships with all
965		-	health insurers, the highest aggregate re tained rebate
966		-	percentage, the lowest aggregate retained rebate
967	938		percentage, and the mean aggregate retained rebate
968	939		percentage,
969	940		i. the individual and aggregate amount paid by the health
970	941		insurer payor to the PBM for pharmacy services
971	942		itemized by pharmacy, dru g product and service
972	943		provided, and
973	944		e.
974	945		j. the individual and aggregate amount a PBM paid a
975	946		provider for pharmacy services itemize d by pharmacy,
976	947		drug product and service provided.
977	948		The Department shall publish in a timely manner the information
978	949		that it receives under paragraph 5 of this subsection on a publicly
979	950		available website; provided that such information shall be made
980	951		available in a form that does not disclose the identity of a
981	952		specific health plan or the identity of a specific manufacturer, the
982	953		prices charged for specific drugs or classes of drugs, or the amount
983	954		of any rebates provided for specific drugs or classes of drugs.
	955	+	E. For each of the PBM's contracts or other relationships with
	956	+	a health plan, a PBM shall publish on an easily a ccessible website
	957	+	the health plan formulary, and timely notification of formulary
	958	+	changes and/or product exclusions.
	959	+	F. The PBM and the Department shall not publish or otherwise
	960	+	disclose any information tha t would reveal the identity of a
	961	+	specific health plan, the price(s ) charged for a specific drug or
984	962
985		-	SENATE FLOOR VERSION - HB2853 SFLR Page 20
986		-	(Bold face denotes Committee Amendments) 1
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1010	987
1011		-	E. For each of the PBM's contracts or other relationships with
1012		-	a health plan, a PBM shall publish on an easily a ccessible website
1013		-	the health plan formulary, and timely notification of formulary
1014		-	changes and/or product exclusions.
1015		-	F. The PBM and the Department shall not publish or otherwise
1016		-	disclose any information tha t would reveal the identity of a
1017		-	specific health plan, the price(s ) charged for a specific drug or
1018	988		class of drugs, the amount of any rebates provided for a specific
1019	989		drug or class of drugs, the manufacturer, or that wou ld otherwise
1020	990		have the potential to com promise the financial, competitive, or
1021	991		proprietary nature of the information. Any such information shall
1022	992		be protected from disclosure as confidential and proprietary
1023	993		information, is not a public record as defined in t he Oklahoma Open
1024	994		Records Act, Section 24A.1 et seq. of Title 51 of the Oklahoma
1025	995		Statutes, and shall not be disclosed directly or indirectly. A PBM
1026	996		shall impose the confidentiality protections of this section o n any
1027	997		vendor or downstream third party that pe rforms health care or
1028	998		administrative services on behalf of the PBM and that may receive or
1029	999		have access to rebate information.
1030	1000		SECTION 6. AMENDATORY 36 O.S. 2021, Section 6964, is
1031	1001		amended to read as follows:
1032	1002		Section 6964. A. A health insurer's insurer or its agent's,
1033	1003		including pharmacy benefits managers, pharmacy and therapeutics
1034	1004		committee (P&T committee) shall establish a formulary, which shall
	1005	+	be a list of prescription drugs, both generic and brand name, used
	1006	+	by practitioners to identify drugs that offer the greates t overall
	1007	+	value.
	1008	+	B. A health insurer shall prohibit conflicts of interest for
	1009	+	members of the P&T committee. The P&T committee shall review the
	1010	+	formulary annually and must meet the foll owing requirements:
1035	1011
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1062		-	be a list of prescription drugs, both generic and brand name, used
1063		-	by practitioners to identify drugs that offer the greates t overall
1064		-	value.
1065		-	B. A health insurer shall prohibit conflicts of interest for
1066		-	members of the P&T committee. The P&T committee shall review the
1067		-	formulary annually and must meet the foll owing requirements:
1068	1037		1. A person may not serve on a P&T committee if th e person is
1069	1038		currently employed or was employe d within the precedin g year by a
1070	1039		pharmaceutical manufacturer, developer, labeler, wholesaler or
1071		-	distributor. A majority of P&T committee members shall be
1072		-	~~practicing~~ physicians, practicing pharmacists, or both, and shall be
1073		-	~~licensed~~ in Oklahoma;
	1040	+	distributor. A majority of P&T committee members shall be practicing
	1041	+	physicians, practicing pharmacists, or both, and shall be licensed
	1042	+	in Oklahoma;
1074	1043		2. A health insurer shall requi re any member of the P&T
1075	1044		committee to disclose any compensation or funding from a
1076	1045		pharmaceutical manufacturer, deve loper, labeler, wholesaler or
1077	1046		distributor. Such P&T committee member shall be recused from voting
1078	1047		on any product manufactured or sold by suc h pharmaceutical
1079	1048		manufacturer, developer, labeler, wholesaler or distributor. P&T
1080	1049		committee members shall practice in various clinical specialties
1081	1050		that adequately represent the needs of health plan enrollees, and
1082	1051		there shall be an adequate number of high -volume specialists and
1083	1052		specialists treating rare and orphan diseases;
1084	1053		3. The P&T committee shall meet no less frequently than on a
1085	1054		quarterly basis;
	1055	+	4. P&T committee formulary development shall be conducted
	1056	+	pursuant to a transparent process, and formulary decisions and
	1057	+	rationale shall be documented in writing, with any records and
	1058	+	documents relating to the process ava ilable upon request to the
	1059	+	health plan, subject to the conditions in subsection C of this
	1060	+	section. In the case of P&T committee decisions th at relate to
1086	1061
1087		-	SENATE FLOOR VERSION - HB2853 SFLR Page 22
1088		-	(Bold face denotes Committee Amendments) 1
	1062	+	ENGR. H. B. NO. 2853 Page 22 1
1089	1063		2
1090	1064		3
1091	1065		4
1092	1066		5
1093	1067		6
1094	1068		7
1095	1069		8
1096	1070		9
1097	1071		10
1098	1072		11
1099	1073		12
1100	1074		13
1101	1075		14
1102	1076		15
1103	1077		16
1104	1078		17
1105	1079		18
1106	1080		19
1107	1081		20
1108	1082		21
1109	1083		22
1110	1084		23
1111	1085		24
1112	1086
1113		-	4. P&T committee formulary development shall be conducted
1114		-	pursuant to a transparent process, and formulary decisions and
1115		-	rationale shall be documented in writing, with any records and
1116		-	documents relating to the process ava ilable upon request to the
1117		-	health plan, subject to the conditions in subsection C of this
1118		-	section. In the case of P&T committee decisions th at relate to
1119	1087		Medicaid managed care organizations' prescription drug coverage
1120	1088		policies, if the P&T committee relies upon any thi rd party to
1121	1089		provide cost-effectiveness analysis or research, the P&T committee
1122	1090		shall:
1123	1091		a. disclose to the health benefit plan, the state, and
1124	1092		the general public the name of the relevant third
1125	1093		party, and
1126	1094		b. provide a process through which patients and provi ders
1127	1095		potentially impacted by the third party's analysis or
1128	1096		research may provide input to the P&T committee;
1129	1097		5. Specialists with current clinical expertise who actively
1130	1098		treat patients in a specific therapeutic area, and the specific
1131	1099		conditions within a the rapeutic area, shall participate in formulary
1132	1100		decisions regarding each therapeutic area an d specific condition;
1133	1101		6. The P&T committee shall base its clinical decisions on the
1134	1102		strength of scientific evidence, standards of practice, and
1135	1103		nationally accepted tre atment guidelines;
	1104	+	7. The P&T committee shall consider whether a particular drug
	1105	+	has a clinically meaningful therapeutic advant age over other drugs
	1106	+	in terms of safety, effectiveness, or clinical outcome for patient
	1107	+	populations who may be treated with the d rug;
	1108	+	8. The P&T committee shall evaluate and analyze treatment
	1109	+	protocols and procedures related to the health plan's formulary at
	1110	+	least annually;
1136	1111
1137		-	SENATE FLOOR VERSION - HB2853 SFLR Page 23
1138		-	(Bold face denotes Committee Amendments) 1
	1112	+	ENGR. H. B. NO. 2853 Page 23 1
1139	1113		2
1140	1114		3
1141	1115		4
1142	1116		5
1143	1117		6
1144	1118		7
1145	1119		8
1146	1120		9
1147	1121		10
1148	1122		11
1149	1123		12
1150	1124		13
1151	1125		14
1152	1126		15
1153	1127		16
1154	1128		17
1155	1129		18
1156	1130		19
1157	1131		20
1158	1132		21
1159	1133		22
1160	1134		23
1161	1135		24
1162	1136
1163		-	7. The P&T committee shall consider whether a particular drug
1164		-	has a clinically meaningful therapeutic advant age over other drugs
1165		-	in terms of safety, effectiveness, or clinical outcome for patient
1166		-	populations who may be treated with the d rug;
1167		-	8. The P&T committee shall evaluate and analyze treatment
1168		-	protocols and procedures related to the health plan's formulary at
1169		-	least annually;
1170	1137		9. The P&T committee shall review formulary management
1171	1138		activities, including exceptions and appeals processes, prior
1172	1139		authorization, step therapy, quantity limits, generic substitutions,
1173	1140		therapeutic interchange, a nd other drug utilizati on management
1174	1141		activities for clinical appropriateness and consistency with
1175	1142		industry standards and patient and provider organization guidelines;
1176	1143		10. The P&T committee shall annually review and provide a
1177	1144		written report to the pharmacy benefits manager on:
1178	1145		a. the percentage of prescription drugs on formulary
1179	1146		subject to each of the types of utilization management
1180	1147		described in paragraph 9 of this subsection,
1181	1148		b. rates of adherence and nonadherence to medicines by
1182	1149		therapeutic area,
1183	1150		c. rates of abandonment of medicines by therapeutic area,
1184	1151		d. recommendations for improved adherence and reduced
1185	1152		abandonment,
	1153	+	e. recommendations for improvement in formulary
	1154	+	management practices consistent with patient and
	1155	+	provider organization and other clinica l guidelines;
	1156	+	provided that the report shall be subject to the
	1157	+	conditions in subsection C of this section;
	1158	+	11. The P&T committee shall review and make a fo rmulary
	1159	+	decision on a new U.S. Food and Drug Administration approved drug
1186	1160
1187		-	SENATE FLOOR VERSION - HB2853 SFLR Page 24
1188		-	(Bold face denotes Committee Amendments) 1
	1161	+	ENGR. H. B. NO. 2853 Page 24 1
1189	1162		2
1190	1163		3
1191	1164		4
1192	1165		5
1193	1166		6
1194	1167		7
1195	1168		8
1196	1169		9
1197	1170		10
1198	1171		11
1199	1172		12
1200	1173		13
1201	1174		14
1202	1175		15
1203	1176		16
1204	1177		17
1205	1178		18
1206	1179		19
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1208	1181		21
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1210	1183		23
1211	1184		24
1212	1185
1213		-	e. recommendations for improvement in formulary
1214		-	management practices consistent with patient and
1215		-	provider organization and other clinical guidelines;
1216		-	provided that the report shall be subject to the
1217		-	conditions in subsection C of this section;
1218		-	11. The P&T committee shall review and make a fo rmulary
1219		-	decision on a new U.S. Food and Drug Administration approved drug
1220	1186		within ninety (90) days of such drug's approval, or shall provide a
1221	1187		clinical justification if this time frame is not met;
1222	1188		12. The P&T committee shall review procedures for medical
1223	1189		review of, and transiti oning new plan enrollees to, appropria te
1224	1190		formulary alternatives to en sure that such procedures a ppropriately
1225	1191		address situations involving enrollees stabilized on drugs that are
1226	1192		not on the health plan formulary (or that are on formulary but
1227	1193		subject to prior authorization, step therapy, or other utilization
1228	1194		management requirements).
1229	1195		C. The health insurer, its agents, including pharmacy benefits
1230	1196		managers, and the Department shall not publish or otherwise disclose
1231	1197		any confidential, propriet ary information, inc luding, but not
1232	1198		limited to, any information that would reveal the identi ty of a
1233	1199		specific health plan, the prices charged for a specific drug or
1234	1200		class of drugs, the amount of any rebates provided for a specific
1235	1201		drug or class of drugs, th e manufacturer, or t hat would otherwise
1236	1202		have the potential to compromise the financial, co mpetitive, or
	1203	+	proprietary nature of the information. Any such information shall
	1204	+	be protected from disclosure as confidential and proprietary
	1205	+	information, is not a pu blic record as defin ed in the Oklahoma Open
	1206	+	Records Act, Section 24A.1 et seq. of Title 51 of the Oklaho ma
	1207	+	Statutes, and shall not be disclosed directly or indirectly. A
	1208	+	health insurer shall impose the confidentiality protections of this
	1209	+	section on any vendor or downstream t hird party that performs health
1237	1210
1238		-	SENATE FLOOR VERSION - HB2853 SFLR Page 25
1239		-	(Bold face denotes Committee Amendments) 1
	1211	+	ENGR. H. B. NO. 2853 Page 25 1
1240	1212		2
1241	1213		3
1242	1214		4
1243	1215		5
1244	1216		6
1245	1217		7
1246	1218		8
1247	1219		9
1248	1220		10
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1250	1222		12
1251	1223		13
1252	1224		14
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1256	1228		18
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1259	1231		21
1260	1232		22
1261	1233		23
1262	1234		24
1263	1235
1264		-	proprietary nature of the information. Any such information shall
1265		-	be protected from disclosure as confidential and proprietary
1266		-	information, is not a pu blic record as defin ed in the Oklahoma Open
1267		-	Records Act, Section 24A.1 et seq. of Title 51 of the Oklaho ma
1268		-	Statutes, and shall not be disclosed directly or indirectly. A
1269		-	health insurer shall impose the confidentiality protections of this
1270		-	section on any vendor or downstream t hird party that performs health
1271	1236		care or administrative services on behalf of the pharmac y benefits
1272	1237		manager that may receive or have access to rebate information.
1273	1238		SECTION 7. NEW LAW A new section of law to be codified
1274	1239		in the Oklahoma Statutes as Section 6962.2 of Title 36, unless there
1275	1240		is created a duplication in numbering, reads as fo llows:
1276	1241		A. An enrollee's defined cost sharing for each prescription
1277	1242		drug shall be calculated at the point of s ale based on a price that
1278	1243		is reduced by an amount equal to at least eighty-five percent (85%)
1279	1244		of all rebates received, or to be received, in connection with the
1280	1245		dispensing or administration of the prescription drug.
1281	1246		B. For any violation of this section, the Insurance
1282	1247		Commissioner may subject a PB M to an administrative penalty of not
1283	1248		less than One Hundred Dollars ( $100.00) nor more than Ten Thousand
1284	1249		Dollars ($10,000.00) for each occurrence. Such administrative
1285	1250		penalty may be enforced in the same manner in w hich civil judgments
1286	1251		may be enforced.
	1252	+	C. Nothing in subsections A and B of this section shall
	1253	+	preclude a PBM from decreasing an enrollee 's defined cost sharing by
	1254	+	an amount greater than that required under subsection A of this
	1255	+	section.
	1256	+	D. In implementing the requi rements of this section, the st ate
	1257	+	shall only regulate a PBM to the extent permissible under applicable
	1258	+	law.
1287	1259
1288		-	SENATE FLOOR VERSION - HB2853 SFLR Page 26
1289		-	(Bold face denotes Committee Amendments) 1
	1260	+	ENGR. H. B. NO. 2853 Page 26 1
1290	1261		2
1291	1262		3
1292	1263		4
1293	1264		5
1294	1265		6
1295	1266		7
1296	1267		8
1297	1268		9
1298	1269		10
1299	1270		11
1300	1271		12
1301	1272		13
1302	1273		14
1303	1274		15
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1305	1276		17
1306	1277		18
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1310	1281		22
1311	1282		23
1312	1283		24
1313	1284
1314		-	C. Nothing in subsections A and B of this section shall
1315		-	preclude a PBM from decreasing an enrollee 's defined cost sharing by
1316		-	an amount greater than that required under subsection A of this
1317		-	section.
1318		-	D. In implementing the requi rements of this section, the st ate
1319		-	shall only regulate a PBM to the extent permissible under applicable
1320		-	law.
1321	1285		E. In complying with the provisions of this section, a PBM or
1322	1286		its agents shall not publish or otherwise reveal information
1323	1287		regarding the actual amount of reb ates a PBM receives on a product
1324	1288		or therapeutic class of p roducts, manufacturer, or pharmacy -specific
1325	1289		basis. Such information is protected as a trade secret, is not a
1326	1290		public record as defined in the Oklahoma Open Records Act, Section
1327	1291		24A.1 et seq. of Title 51 of the Oklahoma Statutes, and shall not be
1328	1292		disclosed directly or indirectly, or in a manner that would allow
1329	1293		for the identification of an individual product, therapeutic class
1330	1294		of products, or manufacturer, or in a manner that would have the
1331	1295		potential to compromise the fi nancial, competitive, or proprietary
1332	1296		nature of the information. A PBM shall impose the confidentiality
1333	1297		protections of this section on any vendor or downstream third party
1334	1298		that performs health care or administrative services on behalf o f
1335	1299		the insurer that may receive or have access to rebate information.
	1300	+	SECTION 8. NEW LAW A new sectio n of law to be codified
	1301	+	in the Oklahoma Statutes as Section 6970 of Title 36, unless there
	1302	+	is created a duplication in numbering, reads as follows:
	1303	+	A. For purposes of this section:
	1304	+	1. "Defined cost sharing" means a deductible payment or
	1305	+	coinsurance amount imposed on an enrollee for a covered prescription
	1306	+	drug under the enrollee's health plan;
	1307	+	2. "Insurer" means any health insurance issuer that is subje ct
	1308	+	to state law regulating in surance and offers health insuranc e
1336	1309
1337		-	SENATE FLOOR VERSION - HB2853 SFLR Page 27
1338		-	(Bold face denotes Committee Amendments) 1
	1310	+	ENGR. H. B. NO. 2853 Page 27 1
1339	1311		2
1340	1312		3
1341	1313		4
1342	1314		5
1343	1315		6
1344	1316		7
1345	1317		8
1346	1318		9
1347	1319		10
1348	1320		11
1349	1321		12
1350	1322		13
1351	1323		14
1352	1324		15
1353	1325		16
1354	1326		17
1355	1327		18
1356	1328		19
1357	1329		20
1358	1330		21
1359	1331		22
1360	1332		23
1361	1333		24
1362	1334
1363		-	SECTION 8. NEW LAW A new sectio n of law to be codified
1364		-	in the Oklahoma Statutes as Section 6970 of Title 36, unless there
1365		-	is created a duplication in numbering, reads as follows:
1366		-	A. For purposes of this section:
1367		-	1. "Defined cost sharing" means a deductible payment or
1368		-	coinsurance amount imposed on an enrollee for a covered prescription
1369		-	drug under the enrollee's health plan;
1370		-	2. "Insurer" means any health insurance issuer that is subje ct
1371		-	to state law regulating in surance and offers health insurance
1372	1335		coverage, as defined in 42 U.S.C. , Section 300gg-91, or any state or
1373	1336		local governmental employer plan;
1374	1337		3. "Price protection rebate" means a negotiated price
1375	1338		concession that accrues directly or indirectly to the insurer, or
1376	1339		other party on behalf of the i nsurer, in the event of an increase in
1377	1340		the wholesale acquisition cost of a drug above a specified
1378	1341		threshold;
1379	1342		4. "Rebate" means:
1380	1343		a. negotiated price concessions including , but not
1381	1344		limited to, base price concessions (whethe r described
1382	1345		as a rebate or otherwise) and reasonable estimates of
1383	1346		any price protection rebates and performance-based
1384	1347		price concessions that may accrue directly or
1385	1348		indirectly to the insurer during the coverag e year
1386	1349		from a manufacturer, dispensing pharmacy, or other
	1350	+	party in connection with the dispensing or
	1351	+	administration of a pre scription drug, and
	1352	+	b. reasonable estimates of any negotiated price
	1353	+	concessions, fees, and other administrative costs that
	1354	+	are passed through, or are re asonably anticipated to
	1355	+	be passed through, to the insurer and s erve to reduce
	1356	+	the insurer's liabilities for a prescription drug.
	1357	+	B. An enrollee's defined cost sharing for each prescription
	1358	+	drug shall be calculated at the point of sale based on a price tha t
1387	1359
1388		-	SENATE FLOOR VERSION - HB2853 SFLR Page 28
1389		-	(Bold face denotes Committee Amendments) 1
	1360	+	ENGR. H. B. NO. 2853 Page 28 1
1390	1361		2
1391	1362		3
1392	1363		4
1393	1364		5
1394	1365		6
1395	1366		7
1396	1367		8
1397	1368		9
1398	1369		10
1399	1370		11
1400	1371		12
1401	1372		13
1402	1373		14
1403	1374		15
1404	1375		16
1405	1376		17
1406	1377		18
1407	1378		19
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1409	1380		21
1410	1381		22
1411	1382		23
1412	1383		24
1413	1384
1414		-	party in connection with the dispensing or
1415		-	administration of a pre scription drug, and
1416		-	b. reasonable estimates of any negotiated price
1417		-	concessions, fees, and other administrative costs that
1418		-	are passed through, or are re asonably anticipated to
1419		-	be passed through, to the insurer and serve to reduce
1420		-	the insurer's liabilities for a prescription drug.
1421		-	B. An enrollee's defined cost sharing for each prescription
1422		-	drug shall be calculated at the point of sale based on a price tha t
1423	1385		is reduced by an amount equ al to at least eighty-five percent (85%)
1424	1386		of all rebates received, or to be received, in connection with the
1425	1387		dispensing or administration of the prescription drug.
1426	1388		C. For any violation of this section, the I nsurance
1427	1389		Commissioner may subject an insurer to an administrative penalty of
1428	1390		not less than One Hundred Dollars ($100.00) nor more than Ten
1429	1391		Thousand Dollars ($10,000.00) for each occurrence. Such
1430	1392		administrative penalty may be enforced in the same manner in which
1431	1393		civil judgments may be enforced.
1432	1394		D. Nothing in subsections A through C of this section shall
1433	1395		preclude an insurer fro m decreasing an enrollee's defined cost
1434	1396		sharing by an amount greater than that required under subsection B
1435	1397		of this section.
	1398	+	E. In implementing the requ irements of this section, the state
	1399	+	shall only regulate an insurer to the extent permissible under
	1400	+	applicable law.
	1401	+	F. In complying with the provisions of this section, an insurer
	1402	+	or its agents shall not publish or otherwise reveal info rmation
	1403	+	regarding the actual amount of rebates an insurer receives on a
	1404	+	product or therapeutic class of pr oducts, manufacturer, or pharmacy-
	1405	+	specific basis. Such information is protected as a trade secret, is
	1406	+	not a public record as defined in the Oklahoma Open Records Act,
	1407	+	Section 24A.1 et seq. of Title 51 of the Oklahoma Statutes, and
	1408	+	shall not be disclosed directly or indirectly, or in a manner that
1436	1409
1437		-	SENATE FLOOR VERSION - HB2853 SFLR Page 29
1438		-	(Bold face denotes Committee Amendments) 1
	1410	+	ENGR. H. B. NO. 2853 Page 29 1
1439	1411		2
1440	1412		3
1441	1413		4
1442	1414		5
1443	1415		6
1444	1416		7
1445	1417		8
1446	1418		9
1447	1419		10
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1450	1422		13
1451	1423		14
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1459	1431		22
1460	1432		23
1461	1433		24
1462	1434
1463		-	E. In implementing the requ irements of this section, the state
1464		-	shall only regulate an insurer to the extent permissible under
1465		-	applicable law.
1466		-	F. In complying with the provisions of this section, an insurer
1467		-	or its agents shall not publish or otherwise reveal info rmation
1468		-	regarding the actual amount of rebates an insurer receives on a
1469		-	product or therapeutic class of pr oducts, manufacturer, or pharmacy-
1470		-	specific basis. Such information is protected as a trade secret, is
1471		-	not a public record as defined in the Oklahoma Open Records Act,
1472		-	Section 24A.1 et seq. of Title 51 of the Oklahoma Statutes, and
1473		-	shall not be disclosed directly or indirectly, or in a manner that
1474	1435		would allow for the identification of an individual product,
1475	1436		therapeutic class of product s, or manufacturer, or in a manner tha t
1476	1437		would have the potential to compromise the financial, competitive,
1477	1438		or proprietary nature of the information. An insurer shall impose
1478	1439		the confidentiality protections of this section on any vendor or
1479	1440		downstream third party that performs health care or adm inistrative
1480	1441		services on behalf of the insurer and that may receive or have
1481	1442		access to rebate information.
1482	1443		SECTION 9. This act shall become effective November 1, 2023.
1483		-	COMMITTEE REPORT BY: COMMITTEE ON RETIREMENT AND INSURANCE
1484		-	April 11, 2023 - DO PASS
	1444	+	Passed the House of Representatives the 20th day of March, 2023.
	1445	+
	1446	+
	1447	+
	1448	+
	1449	+	Presiding Officer of the House
	1450	+	of Representatives
	1451	+
	1452	+
	1453	+	Passed the Senate the ____ day of __________, 2023.
	1454	+
	1455	+
	1456	+
	1457	+
	1458	+	Presiding Officer of the Senate
	1459	+
	1460	+