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HOUSE OF REPRESENTATIVES - FLOOR VERSION
STATE OF OKLAHOMA
2nd Session of the 59th Legislature (2024)
HOUSE BILL 3368 By: McEntire
AS INTRODUCED
An Act relating to health insurance; creating the
Patients Pay Less Act; providing for noncodification;
limiting cost sharing; regulating pharmacy benefits
managers; promulgating rules; providing definitions;
limiting cost sharing ; regulating health insurers and
administrators; amending 36 O.S. 2021, Section 6960,
as amended by Section 1, Chapter 38, O.S.L. 2022 (36
O.S. Supp. 2023, Secti on 6960), which relates to
Patient's Right to Pharmacy Choice Act definitio ns;
adding definitions; providing for noncodification;
providing for codification; and providing an
effective date.
BE IT ENACTED BY THE PEOPLE OF T HE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new section of law not to be
codified in the Oklahoma Statutes reads as follows:
This act shall be known and may be cited as the "Patients Pay
Less Act".
SECTION 2. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 6962.1 of Title 36, unless there
is created a duplication in numbering, reads as follows:
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A. The annual limitation on cost sharing provided for under 42
U.S.C., Section 18022(c)(1) shall apply to a ll health care services
covered under any health plan offered or issued by a health insurer
in this state, including a health plan administ ered by a pharmacy
benefits manager.
B. A pharmacy benefits m anager shall not directly or indirectly
set, alter, implement, or condition the terms of health plan
coverage, including the benefit design, based in part or entirely on
information about the ava ilability or amount of financia l or product
assistance available for a prescription drug.
C. Annually by December 3 1, a pharmacy benefits manager shall
certify to the Insurance Commissioner that it has fully and
completely complied with the requirements of this section throughout
the prior calendar year. Such certification must be signed by the
chief executive officer or chief financial officer of the pharmacy
benefits manager.
D. This section shall apply with respect to health plans that
are entered into, amended, extended, or renewe d on or after January
1, 2025.
E. In implementing the requirements of this section, the state
shall only regulate a health insurer, health plan, or pharmacy
benefits manager to the extent permissible under applicab le law.
F. The Insurance Department may promulgate rules to effe ctuate
the provisions of this section.
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SECTION 3. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 6969 of Title 36, unless there
is created a duplication in numbering, reads as follows:
A. Notwithstanding any other provision of law, for purposes of
the Patients Pay Less Act:
1. "Administrator" has the same meaning as that term is defined
in Section 1442 of Title 36 of the Oklahoma Statutes , with respect
to any person who admin isters a health plan subject to the insuran ce
laws and rules of insurance in this sta te or subject to the
jurisdiction of the Insurance Department ;
2. "Cost sharing" means any copayment, coinsurance, deductible,
or other similar charges required of an enr ollee for a health care
service covered by a health plan, including a prescription dr ug, and
paid by or on behalf of such enrollee ;
3. "Enrollee" means any individual entitled to health care
services from a health insurer ;
4. "Health care service" means an item or service furnished to
any individual for the purpose of preventing, alleviating, curing,
or healing human illness, injury , or physical disability ;
5. "Health insurer" has the same meaning as that term is
defined in Section 6960 of Title 36 of the Oklahoma Statutes;
6. "Health plan" means a policy, contract, certification, or
agreement offered or issued by a healt h insurer to provide, deliver,
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arrange for, pay for, or reimburse any of the costs of health care
services; and
7. "Person" means a natural person, corporation, mutual
company, unincorporated association, part nership, joint venture,
limited liability company, trust, estate, foundation, not -for-profit
corporation, unincorporated organization, government , or
governmental subdivision or ag ency.
B. The annual limitation on cost sharing provided for under 42
U.S.C., Section 18022(c)(1) shall apply to all health care services
covered under any health plan offered or issued by a health insurer
in this state.
C. A health insurer or administrat or shall not directly or
indirectly set, alter, implement, or condition the terms of health
plan coverage, including the benefit design, based in part or
entirely on information about the availability or amount of
financial or product assistance available for a prescription drug.
D. Annually by December 31, each health insurer or
administrator must certify to the Insurance Commissioner that it has
fully and completely complied with the requirements of this section
throughout the prior calendar year. Such certification must be
signed by the chief executive officer or chief financial officer of
the health insurer or administrator.
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E. This section shall apply with respect to health plans that
are entered into, amended, extended, or renewed on or after January
1, 2025.
F. In implementing the requirem ents of this section, the state
shall only regulate a health insurer, health plan, or administrator
to the extent permissible under applicable law.
G. The Insurance Department may promulgate rules to effectuate
the provisions of this section.
SECTION 4. AMENDATORY 36 O.S. 2021, Section 6960, as
amended by Section 1, Chapter 38, O.S.L. 2022 (36 O.S. Supp. 2023,
Section 6960), is amended to read as follows:
Section 6960. For Notwithstanding any other provision of law,
for purposes of the Patient's Right to Pharmacy Choi ce Act:
1. "Cost sharing" means any copayment, coinsurance, deductible,
or other similar charges required of an enrollee for a health care
service covered by a health plan, including a prescription drug, and
paid by or on behalf of such enrollee;
2. "Enrollee" means any individual entitled to health care
services from a health insurer;
3. "Health care service" means an item or service furnished to
any individual for the pur pose of preventing, alleviating, curing,
or healing human illness, injury, or physical disability;
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4. "Health insurer" means any corporation, association, benefit
society, exchange, partnership or individ ual licensed by the
Oklahoma Insurance Code;
2. 5. "Health insurer payor" means a health insurance company,
health maintenance organiz ation, union, hospital and medical
services organization or any entity providing or admin istering a
self-funded health benefit plan;
6. "Health plan" means a policy, contr act, certification, or
agreement offered or issued by a health insurer to provide, d eliver,
arrange for, pay for, or reimburse any of the costs of health care
services;
3. 7. "Mail-order pharmacy" means a pharmacy licensed by this
state that primarily dis penses and delivers covered drugs via commo n
carrier;
4. 8. "Pharmacy benefits manag er" or "PBM" means a person that,
either directly or through an intermediary, performs pharmacy
benefits management, as defined in paragraph 6 of Section 357 of
Title 59 of the Oklahoma Statutes, and any other person acting for
such person under a contract ual or employment relationship in the
performance of pharmacy benefits management for a managed -care
company, nonprofit hospital, medical service organization, insurance
company, third-party payor or a health program administered by a
department of this st ate;
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9. "Person" means a natural person, corporation, mutual
company, unincorporated association, partnership, joint venture,
limited liability company, trust, estate, fo undation, not-for-profit
corporation, unincorporated organization, government , or
governmental subdivision or agency;
5. 10. "Provider" means a pharmacy, as defined in Section 353.1
of Title 59 of the Oklahoma Statutes or an agent or representative
of a pharmacy;
6. 11. "Retail pharmacy network " means retail pharmacy
providers contracted with a PBM in which the pharmacy primarily
fills and sells prescriptions via a retail, storefront location;
7. 12. "Rural service area" means a five-digit ZIP code in
which the population density is less than one thousand (1,000)
individuals per square mile;
8. 13. "Spread pricing" means a prescription drug pricing model
utilized by a pharmacy benefits manager in which the PBM charges a
health benefit plan a contracted p rice for prescription drugs that
differs from the amount the PBM directl y or indirectly pays the
pharmacy or pharmacist for providing pharmacy services;
9. 14. "Suburban service area " means a five-digit ZIP code in
which the population density is between one thousand (1,000) and
three thousand (3,000) individuals per square mile ; and
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10. 15. "Urban service area" means a five-digit ZIP code in
which the population density is greater than three thousand (3,000)
individuals per square mile.
SECTION 5. This act shall become effective November 1, 2024.
COMMITTEE REPORT BY: COMMITTEE ON INSURANCE, dated 02/22/2024 - DO
PASS.