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STATE OF OKLAHOMA
2nd Session of the 59th Legislature (2024)
SENATE BILL 1567 By: Daniels
AS INTRODUCED
An Act relating to pharmacy benefits management;
amending 36 O.S. 2021, Section 6960, as amended by
Section 1, Chapter 38, O.S.L. 2022 (36 O.S. Supp.
2023, Section 6960), which relates to the Patient ’s
Right to Pharmacy Choice Act; modifying definition;
updating statutory language; amending 59 O.S. 2021,
Section 357, which relates to the Pharmacy Audit
Integrity Act; modifying definition; updating
statutory references; and providing an effective
date.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. 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 purposes of the Patient ’s Right to Pharmacy
Choice Act:
1. “Health insurer” means any corporation, association, benefit
society, exchange, partnership or individ ual licensed by the
Oklahoma Insurance Code;
2. “Health insurer payor” means a health insurance company,
health maintenance organization, union, hospital and medical
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services organization or any entity providing or admin istering a
self-funded health benefit plan;
3. “Mail-order pharmacy” means a pharmacy licensed by this
state that primarily dispenses and delivers covered drugs via common
carrier;
4. “Pharmacy benefits manager ” or “PBM” means a person that
performs pharmacy benefits management , as defined in Section 357 of
Title 59 of the Oklahoma Statutes, and any other person acting for
such person under a contractual or employm ent relationship in the
performance of pharmacy benefits management for a managed-care
managed care company, nonprofit hospital, medica l service
organization, insurance company, third -party payor or a health
program administered by a department of this state;
5. “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. “Retail pharmacy network” means retail pharmacy providers
contracted with a PBM in which the pharmacy primari ly fills and
sells prescriptions via a retail, storefront location;
7. “Rural service area” means a five-digit ZIP code in which
the population density is less than one thousand (1,000) individu als
per square mile;
8. “Spread pricing” means a prescription drug pricing model
utilized by a pharmacy benefits manager in which the PBM cha rges a
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health benefit plan a contracted price for prescription drugs that
differs from the amount the PBM dir ectly or indirectly pays the
pharmacy or pharmacist for pr oviding pharmacy services;
9. “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
10. “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 2. AMENDATORY 59 O.S. 202 1, Section 357, is
amended to read as follows:
Section 357. As used in this act Section 357 et seq. of this
title:
1. “Covered entity” means a nonprofit hospital or medical
service organization, insurer, health coverage plan or h ealth
maintenance organization; a health program administered by the state
in the capacity of provider of health coverage; or an employer,
labor union, or other entity organized in the state that provides
health coverage to covered individuals who are empl oyed or reside in
the state. This term does not include a workers’ compensation
insurer or health plan that provides coverage only for accidental
injury, specified disease , hospital indemnity, disability income, or
other limited benefit health insurance p olicies and contracts that
do not include prescription drug coverage;
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2. “Covered individual” means a member, participant, enrollee,
contract holder or policy holder or beneficiary of a covered entity
who is provided health coverage by the covered entity. A covered
individual includes any depen dent or other person provide d health
coverage through a policy, contract or plan for a covered
individual;
3. “Department” means the Oklahoma Insurance Department;
4. “Maximum allowable cost ” or “MAC” means the list of drug
products delineating the maximum per -unit reimbursement for
multiple-source prescription drugs, medical product or device;
5. “Multisource drug product reimbursement ” (reimbursement)
means the total amount paid to a pharmacy inclusive of any re duction
in payment to the pharmacy, excluding prescription dispense f ees;
6. “Pharmacy benefits management ” means a service provided to
covered entities to facilitate the provision o f prescription drug
benefits to covered individuals within the state, inc luding
negotiating pricing and other terms with drug manufacturers and
providers. Pharmacy benefits management may include any or all of
the following services:
a. claims processing, retail network management and
payment of claims to pharmacies for prescr iption drugs
dispensed to covered individuals,
b. clinical formulary development and management
services,
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c. rebate contracting and administration,
d. certain patient compliance, ther apeutic intervention
and generic substitution programs, or
e. disease management programs;
7. “Pharmacy benefits manager ” or “PBM” means a person,
business or other entity that performs pharmacy benefits management.
The term includes a person or entity acting for a PBM in a
contractual or employment relationship in the perfor mance of
pharmacy benefits management for a managed care company, non profit
hospital, medical service organization, insurance company, third -
party payor, or a health program administe red by an agency of this
state;
8. “Plan sponsor” means the employers, i nsurance companies,
unions and health maintenance organizations or any other entity
responsible for establishing, maintaining, or administering a health
benefit plan on behalf of covered individuals; and
9. “Provider” means a pharmacy licensed by the Stat e Board of
Pharmacy, or an agent or representative of a pharmacy, inc luding,
but not limited to, the pharmacy ’s contracting agent, which
dispenses prescription drugs or devices to cov ered individuals.
SECTION 3. This act shall become effec tive November 1, 2024.
59-2-3060 RD 1/5/2024 3:26:54 PM