Old	New	Differences
1	1
2	2
3	3
4	4	Req. No. 3060 Page 1 1
5	5	2
6	6	3
7	7	4
8	8	5
9	9	6
10	10	7
11	11	8
12	12	9
13	13	10
14	14	11
15	15	12
16	16	13
17	17	14
18	18	15
19	19	16
20	20	17
21	21	18
22	22	19
23	23	20
24	24	21
25	25	22
26	26	23
27	27	24
28	28	1
29	29	2
30	30	3
31	31	4
32	32	5
33	33	6
34	34	7
35	35	8
36	36	9
37	37	10
38	38	11
39	39	12
40	40	13
41	41	14
42	42	15
43	43	16
44	44	17
45	45	18
46	46	19
47	47	20
48	48	21
49	49	22
50	50	23
51	51	24
52	52
53	53	STATE OF OKLAHOMA
54	54
55	55	2nd Session of the 59th Legislature (2024)
56	56
57	57	SENATE BILL 1567 By: Daniels
58	58
59	59
60	60
61	61
62	62
63	63	AS INTRODUCED
64	64
65	65	An Act relating to pharmacy benefits management;
66	66	amending 36 O.S. 2021, Section 6960, as amended by
67	67	Section 1, Chapter 38, O.S.L. 2022 (36 O.S. Supp.
68	68	2023, Section 6960), which relates to the Patient ’s
69	69	Right to Pharmacy Choice Act; modifying definition;
70	70	updating statutory language; amending 59 O.S. 2021,
71	71	Section 357, which relates to the Pharmacy Audit
72	72	Integrity Act; modifying definition; updating
73	73	statutory references; and providing an effective
74	74	date.
75	75
76	76
77	77
78	78
79	79	BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
80	80	SECTION 1. AMENDATORY 36 O.S. 2021, Section 6960, as
81	81	amended by Section 1, Chapter 38, O.S.L. 2022 (36 O.S. Supp. 2023,
82	82	Section 6960), is amended to read as follows:
83	83	Section 6960. For purposes of the Patient ’s Right to Pharmacy
84	84	Choice Act:
85	85	1. “Health insurer” means any corporation, association, benefit
86	86	society, exchange, partnership or individ ual licensed by the
87	87	Oklahoma Insurance Code;
88	88	2. “Health insurer payor” means a health insurance company,
89	89	health maintenance organization, union, hospital and medical
90	90
91	91
92	92	Req. No. 3060 Page 2 1
93	93	2
94	94	3
95	95	4
96	96	5
97	97	6
98	98	7
99	99	8
100	100	9
101	101	10
102	102	11
103	103	12
104	104	13
105	105	14
106	106	15
107	107	16
108	108	17
109	109	18
110	110	19
111	111	20
112	112	21
113	113	22
114	114	23
115	115	24
116	116	1
117	117	2
118	118	3
119	119	4
120	120	5
121	121	6
122	122	7
123	123	8
124	124	9
125	125	10
126	126	11
127	127	12
128	128	13
129	129	14
130	130	15
131	131	16
132	132	17
133	133	18
134	134	19
135	135	20
136	136	21
137	137	22
138	138	23
139	139	24
140	140
141	141	services organization or any entity providing or admin istering a
142	142	self-funded health benefit plan;
143	143	3. “Mail-order pharmacy” means a pharmacy licensed by this
144	144	state that primarily dispenses and delivers covered drugs via common
145	145	carrier;
146	146	4. “Pharmacy benefits manager ” or “PBM” means a person that
147	147	performs pharmacy benefits management , as defined in Section 357 of
148	148	Title 59 of the Oklahoma Statutes, and any other person acting for
149	149	such person under a contractual or employm ent relationship in the
150	150	performance of pharmacy benefits management for a managed-care
151	151	managed care company, nonprofit hospital, medica l service
152	152	organization, insurance company, third -party payor or a health
153	153	program administered by a department of this state;
154	154	5. “Provider” means a pharmacy, as defined in Section 353.1 of
155	155	Title 59 of the Oklahoma Statutes or an agent or representative of a
156	156	pharmacy;
157	157	6. “Retail pharmacy network” means retail pharmacy providers
158	158	contracted with a PBM in which the pharmacy primari ly fills and
159	159	sells prescriptions via a retail, storefront location;
160	160	7. “Rural service area” means a five-digit ZIP code in which
161	161	the population density is less than one thousand (1,000) individu als
162	162	per square mile;
163	163	8. “Spread pricing” means a prescription drug pricing model
164	164	utilized by a pharmacy benefits manager in which the PBM cha rges a
165	165
166	166
167	167	Req. No. 3060 Page 3 1
168	168	2
169	169	3
170	170	4
171	171	5
172	172	6
173	173	7
174	174	8
175	175	9
176	176	10
177	177	11
178	178	12
179	179	13
180	180	14
181	181	15
182	182	16
183	183	17
184	184	18
185	185	19
186	186	20
187	187	21
188	188	22
189	189	23
190	190	24
191	191	1
192	192	2
193	193	3
194	194	4
195	195	5
196	196	6
197	197	7
198	198	8
199	199	9
200	200	10
201	201	11
202	202	12
203	203	13
204	204	14
205	205	15
206	206	16
207	207	17
208	208	18
209	209	19
210	210	20
211	211	21
212	212	22
213	213	23
214	214	24
215	215
216	216	health benefit plan a contracted price for prescription drugs that
217	217	differs from the amount the PBM dir ectly or indirectly pays the
218	218	pharmacy or pharmacist for pr oviding pharmacy services;
219	219	9. “Suburban service area ” means a five-digit ZIP code in which
220	220	the population density is between one thousand (1,000) and three
221	221	thousand (3,000) individuals per square mile ; and
222	222	10. “Urban service area” means a five-digit ZIP code in which
223	223	the population density is greater than three thousand (3,000)
224	224	individuals per square mile.
225	225	SECTION 2. AMENDATORY 59 O.S. 202 1, Section 357, is
226	226	amended to read as follows:
227	227	Section 357. As used in this act Section 357 et seq. of this
228	228	title:
229	229	1. “Covered entity” means a nonprofit hospital or medical
230	230	service organization, insurer, health coverage plan or h ealth
231	231	maintenance organization; a health program administered by the state
232	232	in the capacity of provider of health coverage; or an employer,
233	233	labor union, or other entity organized in the state that provides
234	234	health coverage to covered individuals who are empl oyed or reside in
235	235	the state. This term does not include a workers’ compensation
236	236	insurer or health plan that provides coverage only for accidental
237	237	injury, specified disease , hospital indemnity, disability income, or
238	238	other limited benefit health insurance p olicies and contracts that
239	239	do not include prescription drug coverage;
240	240
241	241
242	242	Req. No. 3060 Page 4 1
243	243	2
244	244	3
245	245	4
246	246	5
247	247	6
248	248	7
249	249	8
250	250	9
251	251	10
252	252	11
253	253	12
254	254	13
255	255	14
256	256	15
257	257	16
258	258	17
259	259	18
260	260	19
261	261	20
262	262	21
263	263	22
264	264	23
265	265	24
266	266	1
267	267	2
268	268	3
269	269	4
270	270	5
271	271	6
272	272	7
273	273	8
274	274	9
275	275	10
276	276	11
277	277	12
278	278	13
279	279	14
280	280	15
281	281	16
282	282	17
283	283	18
284	284	19
285	285	20
286	286	21
287	287	22
288	288	23
289	289	24
290	290
291	291	2. “Covered individual” means a member, participant, enrollee,
292	292	contract holder or policy holder or beneficiary of a covered entity
293	293	who is provided health coverage by the covered entity. A covered
294	294	individual includes any depen dent or other person provide d health
295	295	coverage through a policy, contract or plan for a covered
296	296	individual;
297	297	3. “Department” means the Oklahoma Insurance Department;
298	298	4. “Maximum allowable cost ” or “MAC” means the list of drug
299	299	products delineating the maximum per -unit reimbursement for
300	300	multiple-source prescription drugs, medical product or device;
301	301	5. “Multisource drug product reimbursement ” (reimbursement)
302	302	means the total amount paid to a pharmacy inclusive of any re duction
303	303	in payment to the pharmacy, excluding prescription dispense f ees;
304	304	6. “Pharmacy benefits management ” means a service provided to
305	305	covered entities to facilitate the provision o f prescription drug
306	306	benefits to covered individuals within the state, inc luding
307	307	negotiating pricing and other terms with drug manufacturers and
308	308	providers. Pharmacy benefits management may include any or all of
309	309	the following services:
310	310	a. claims processing, retail network management and
311	311	payment of claims to pharmacies for prescr iption drugs
312	312	dispensed to covered individuals,
313	313	b. clinical formulary development and management
314	314	services,
315	315
316	316
317	317	Req. No. 3060 Page 5 1
318	318	2
319	319	3
320	320	4
321	321	5
322	322	6
323	323	7
324	324	8
325	325	9
326	326	10
327	327	11
328	328	12
329	329	13
330	330	14
331	331	15
332	332	16
333	333	17
334	334	18
335	335	19
336	336	20
337	337	21
338	338	22
339	339	23
340	340	24
341	341	1
342	342	2
343	343	3
344	344	4
345	345	5
346	346	6
347	347	7
348	348	8
349	349	9
350	350	10
351	351	11
352	352	12
353	353	13
354	354	14
355	355	15
356	356	16
357	357	17
358	358	18
359	359	19
360	360	20
361	361	21
362	362	22
363	363	23
364	364	24
365	365
366	366	c. rebate contracting and administration,
367	367	d. certain patient compliance, ther apeutic intervention
368	368	and generic substitution programs, or
369	369	e. disease management programs;
370	370	7. “Pharmacy benefits manager ” or “PBM” means a person,
371	371	business or other entity that performs pharmacy benefits management.
372	372	The term includes a person or entity acting for a PBM in a
373	373	contractual or employment relationship in the perfor mance of
374	374	pharmacy benefits management for a managed care company, non profit
375	375	hospital, medical service organization, insurance company, third -
376	376	party payor, or a health program administe red by an agency of this
377	377	state;
378	378	8. “Plan sponsor” means the employers, i nsurance companies,
379	379	unions and health maintenance organizations or any other entity
380	380	responsible for establishing, maintaining, or administering a health
381	381	benefit plan on behalf of covered individuals; and
382	382	9. “Provider” means a pharmacy licensed by the Stat e Board of
383	383	Pharmacy, or an agent or representative of a pharmacy, inc luding,
384	384	but not limited to, the pharmacy ’s contracting agent, which
385	385	dispenses prescription drugs or devices to cov ered individuals.
386	386	SECTION 3. This act shall become effec tive November 1, 2024.
387	387
388	388	59-2-3060 RD 1/5/2024 3:26:54 PM

Oklahoma 2024 Regular Session

Oklahoma Senate Bill SB1567 Compare Versions