Oklahoma 2024 Regular Session

Oklahoma House Bill HB3368 Compare Versions

Version 1 (Old)

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3		-	~~HB3368 HFLR Page 1~~
4		-	~~BOLD FACE denotes Committee Amendments.~~ 1
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31	53		STATE OF OKLAHOMA
32	54
33	55		2nd Session of the 59th Legislature (2024)
34	56
35	57		HOUSE BILL 3368 By: McEntire
36	58
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40	62
41	63		AS INTRODUCED
42	64
43	65		An Act relating to health insurance; creating the
44	66		Patients Pay Less Act; providing for noncodification;
45	67		limiting cost sharing; regulating pharmacy benefits
46	68		managers; promulgating rules; providing definitions;
47	69		limiting cost sharing ; regulating health insurers and
48	70		administrators; amending 36 O.S. 2021, Section 6960,
49	71		as amended by Section 1, Chapter 38, O.S.L. 2022 (36
50	72		O.S. Supp. 2023, Secti on 6960), which relates to
51	73		Patient's Right to Pharmacy Choice Act definitio ns;
52	74		adding definitions; providing for noncodification;
53	75		providing for codification; and providing an
54	76		effective date.
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59	81		BE IT ENACTED BY THE PEOPLE OF T HE STATE OF OKLAHOMA:
60	82		SECTION 1. NEW LAW A new section of law not to be
61	83		codified in the Oklahoma Statutes reads as follows:
62	84		This act shall be known and may be cited as the "Patients Pay
63	85		Less Act".
64	86		SECTION 2. NEW LAW A new section of law to be codified
65	87		in the Oklahoma Statutes as Section 6962.1 of Title 36, unless there
66	88		is created a duplication in numbering, reads as follows:
	89	+	A. The annual limitation on cost sharing provided for under 42
	90	+	U.S.C., Section 18022(c)(1) shall apply to a ll health care services
67	91
68		-	HB3368 HFLR Page 2
69		-	BOLD FACE denotes Committee Amendments. 1
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94		-	A. The annual limitation on cost sharing provided for under 42
95		-	U.S.C., Section 18022(c)(1) shall apply to a ll health care services
96	142		covered under any health plan offered or issued by a health insurer
97	143		in this state, including a health plan administ ered by a pharmacy
98	144		benefits manager.
99	145		B. A pharmacy benefits m anager shall not directly or indirectly
100	146		set, alter, implement, or condition the terms of health plan
101	147		coverage, including the benefit design, based in part or entirely on
102	148		information about the ava ilability or amount of financia l or product
103	149		assistance available for a prescription drug.
104	150		C. Annually by December 3 1, a pharmacy benefits manager shall
105	151		certify to the Insurance Commissioner that it has fully and
106	152		completely complied with the requirements of this section throughout
107	153		the prior calendar year. Such certification must be signed by the
108	154		chief executive officer or chief financial officer of the pharmacy
109	155		benefits manager.
110	156		D. This section shall apply with respect to health plans that
111	157		are entered into, amended, extended, or renewe d on or after January
112	158		1, 2025.
113	159		E. In implementing the requirements of this section, the state
114	160		shall only regulate a health insurer, health plan, or pharmacy
115	161		benefits manager to the extent permissible under applicab le law.
116	162		F. The Insurance Department may promulgate rules to effe ctuate
117	163		the provisions of this section.
118	164
119		-	HB3368 HFLR Page 3
120		-	BOLD FACE denotes Committee Amendments. 1
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145	215		SECTION 3. NEW LAW A new section of law to be codified
146	216		in the Oklahoma Statutes as Section 6969 of Title 36, unless there
147	217		is created a duplication in numbering, reads as follows:
148	218		A. Notwithstanding any other provision of law, for purposes of
149	219		the Patients Pay Less Act:
150	220		1. "Administrator" has the same meaning as that term is defined
151	221		in Section 1442 of Title 36 of the Oklahoma Statutes , with respect
152	222		to any person who admin isters a health plan subject to the insurance
153	223		laws and rules of insurance in this sta te or subject to the
154	224		jurisdiction of the Insurance Department ;
155	225		2. "Cost sharing" means any copayment, coinsurance, deductible,
156	226		or other similar charges required of an enr ollee for a health care
157	227		service covered by a hea lth plan, including a prescription dr ug, and
158	228		paid by or on behalf of such enrollee ;
159	229		3. "Enrollee" means any individual entitled to health care
160	230		services from a health insurer ;
161	231		4. "Health care service" means an item or service furnished to
162	232		any individual for the purpose of preventing, alleviating, curing,
163	233		or healing human illness, injury , or physical disability ;
164	234		5. "Health insurer" has the same meaning as that term is
165	235		defined in Section 6960 of Title 36 of the Oklahoma Statutes;
166	236		6. "Health plan" means a policy, contract, certification, or
167	237		agreement offered or issued by a healt h insurer to provide, deliver,
168	238
169		-	HB3368 HFLR Page 4
170		-	BOLD FACE denotes Committee Amendments. 1
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195	289		arrange for, pay for, or reimburse any of the costs of health care
196	290		services; and
197	291		7. "Person" means a natural person, corporation, mutual
198	292		company, unincorporated association, part nership, joint venture,
199	293		limited liability company, trust, estate, foundation, not -for-profit
200	294		corporation, unincorporated organization, government , or
201	295		governmental subdivision or ag ency.
202	296		B. The annual limitation on cost sharing provided for under 42
203	297		U.S.C., Section 18022(c)(1) shall apply to all health care services
204	298		covered under any health plan offered or issued by a health insurer
205	299		in this state.
206	300		C. A health insurer or administrat or shall not directly or
207	301		indirectly set, alter, implement, or condition the terms of health
208	302		plan coverage, including the benefit design, based in part or
209	303		entirely on information about the availability or amount of
210	304		financial or product assistance available for a prescription drug.
211	305		D. Annually by December 31, each health insurer or
212	306		administrator must certify to the Insurance Commissioner that it has
213	307		fully and completely complied with the requirements of this section
214	308		throughout the prior calendar year. Such certification must be
215	309		signed by the chief executive officer or chief financial officer of
216	310		the health insurer or administrator.
217	311
218		-	HB3368 HFLR Page 5
219		-	BOLD FACE denotes Committee Amendments. 1
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244	362		E. This section shall apply with respect to health plans that
245	363		are entered into, amended, extended, or renewed on or after January
246	364		1, 2025.
247	365		F. In implementing the requirements of this section, the state
248	366		shall only regulate a health insurer, health plan, or administrator
249	367		to the extent permissible under applicable law.
250	368		G. The Insurance Department may promulgate rules to effectuate
251	369		the provisions of this section.
252	370		SECTION 4. AMENDATORY 36 O.S. 2021, Section 6960, as
253	371		amended by Section 1, Chapter 38, O.S.L. 2022 (36 O.S. Supp. 2023,
254	372		Section 6960), is amended to read as follows:
255	373		Section 6960. For Notwithstanding any other provision of law,
256	374		for purposes of the Patient's Right to Pharmacy Choi ce Act:
257	375		1. "Cost sharing" means any copayment, coinsurance, deductible,
258	376		or other similar charges required of an enrollee for a health care
259	377		service covered by a health plan, including a prescription drug, and
260	378		paid by or on behalf of such enrollee;
261	379		2. "Enrollee" means any individual entitled to health care
262	380		services from a health insurer;
263	381		3. "Health care service" means an item or service furnished to
264	382		any individual for the pur pose of preventing, alleviating, curing,
265	383		or healing human illness, injury, or physical disability;
266	384
267		-	HB3368 HFLR Page 6
268		-	BOLD FACE denotes Committee Amendments. 1
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293	435		4. "Health insurer" means any corporation, association, benefit
294	436		society, exchange, partnership or individ ual licensed by the
295	437		Oklahoma Insurance Code;
296	438		2. 5. "Health insurer payor" means a health insurance company,
297	439		health maintenance organiz ation, union, hospital and medical
298	440		services organization or any entity providing or admin istering a
299	441		self-funded health benefit plan;
300	442		6. "Health plan" means a policy, contr act, certification, or
301	443		agreement offered or issued by a health insurer to provide, d eliver,
302	444		arrange for, pay for, or reimburse any of the costs of health care
303	445		services;
304	446		3. 7. "Mail-order pharmacy" means a pharmacy licensed by this
305	447		state that primarily dis penses and delivers covered drugs via common
306	448		carrier;
307	449		4. 8. "Pharmacy benefits manag er" or "PBM" means a person that,
308	450		either directly or through an intermediary, performs pharmacy
309	451		benefits management, as defined in paragraph 6 of Section 357 of
310	452		Title 59 of the Oklahoma Statutes, and any other person acting for
311	453		such person under a contract ual or employment relationship in the
312	454		performance of pharmacy benefits management for a managed -care
313	455		company, nonprofit hospital, medical service organization, insurance
314	456		company, third-party payor or a health program administered by a
315	457		department of this st ate;
316	458
317		-	HB3368 HFLR Page 7
318		-	BOLD FACE denotes Committee Amendments. 1
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343	509		9. "Person" means a natural person, corporation, mutual
344	510		company, unincorporated association, partnership, joint venture,
345	511		limited liability company, trust, estate, fo undation, not-for-profit
346	512		corporation, unincorporated organization, government , or
347	513		governmental subdivision or agency;
348	514		5. 10. "Provider" means a pharmacy, as defined in Section 353.1
349	515		of Title 59 of the Oklahoma Statutes or an agent or representative
350	516		of a pharmacy;
351	517		6. 11. "Retail pharmacy network " means retail pharmacy
352	518		providers contracted with a PBM in which the pharmacy primarily
353	519		fills and sells prescriptions via a retail, storefront location;
354	520		7. 12. "Rural service area" means a five-digit ZIP code in
355	521		which the population density is less than one thousand (1,000)
356	522		individuals per square mile;
357	523		8. 13. "Spread pricing" means a prescription drug pricing model
358	524		utilized by a pharmacy benefits manager in which the PBM charges a
359	525		health benefit plan a contracted p rice for prescription drugs that
360	526		differs from the amount the PBM directl y or indirectly pays the
361	527		pharmacy or pharmacist for providing pharmacy services;
362	528		9. 14. "Suburban service area " means a five-digit ZIP code in
363	529		which the population density is between one thousand (1,000) and
364	530		three thousand (3,000) individuals per square mile ; and
365	531
366		-	HB3368 HFLR Page 8
367		-	BOLD FACE denotes Committee Amendments. 1
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392	582		10. 15. "Urban service area" means a five-digit ZIP code in
393	583		which the population density is greater than three thousand (3,000)
394	584		individuals per square mile.
395	585		SECTION 5. This act shall become effective November 1, 2024.
396	586
397		-	COMMITTEE REPORT BY: COMMITTEE ON INSURANCE, dated 02/22/2024 - DO
398		-	PASS.
	587	+	59-2-9187 TJ 01/05/24