Oklahoma 2024 Regular Session

Oklahoma Senate Bill SB1581 Compare Versions

Version 1 (Old)

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29		-	SENATE FLOOR VERSION
30		-	February 13, 2024
	53	+	STATE OF OKLAHOMA
31	54
	55	+	2nd Session of the 59th Legislature (2024)
32	56
33		-	SENATE BILL NO. 1581 By: Hicks of the Senate
34		-
35		-	and
36		-
37		-	Marti of the House
	57	+	SENATE BILL 1581 By: Hicks
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	62	+
	63	+	AS INTRODUCED
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43	65		An Act relating to pharmacy benefits manage ment;
44	66		amending 36 O.S. 2021, Section 6962, as last amended
45	67		by Section 1, Chapter 293, O.S.L. 2 023 (36 O.S. Supp.
46	68		2023, Section 6962), which relates to pharmacy
47	69		benefits manager compliance; updating statutory
48	70		reference; requiring pharmacy benefits manager to
49	71		maintain certain fiduciary duty; and providing an
50	72		effective date.
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55	77		BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
56	78		SECTION 1. AMENDATORY 36 O.S. 2021, Section 6962, as
57	79		last amended by Section 1, Chapter 293, O.S.L. 2023 (36 O.S. Supp.
58	80		2023, Section 6962), is amended to read as follows:
59	81		Section 6962. A. The Attorney General shall review and approve
60	82		retail pharmacy network access for all p harmacy benefits managers
61	83		(PBMs) to ensure compliance with Sec tion 6961 of this title.
62	84		B. A PBM, or an agent of a PBM, shall not:
63	85		1. Cause or knowingly pe rmit the use of advertisement,
64	86		promotion, solicitation, representation, proposal or offer th at is
65	87		untrue, deceptive or misleading;
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93	139		2. Charge a pharmacist or phar macy a fee related to the
94	140		adjudication of a claim including without limitation a fee for:
95	141		a. the submission of a claim,
96	142		b. enrollment or participation in a retail pharmacy
97	143		network, or
98	144		c. the development or management of claims processing
99	145		services or claims payment services related to
100	146		participation in a retail pharmacy network;
101	147		3. Reimburse a pharmacy or pharmacist in the state an amount
102	148		less than the amount that the PBM reimburses a phar macy owned by or
103	149		under common ownership with a PBM for providing the s ame covered
104	150		services. The reimbursement amount paid to the pharmacy shall be
105	151		equal to the reimbursement amount calculated on a per-unit basis
106	152		using the same generic product identifier or generic code number
107	153		paid to the PBM-owned or PBM-affiliated pharmacy;
108	154		4. Deny a provider the opportunity to participate in any
109	155		pharmacy network at preferred participation status if the provider
110	156		is willing to accept the terms and conditions that the PBM has
111	157		established for other providers as a condition of preferred networ k
112	158		participation status;
113	159		5. Deny, limit or terminate a provider’s contract based on
114	160		employment status of a ny employee who has an active license to
115	161		dispense, despite probation status, wi th the State Board of
116	162		Pharmacy;
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144	214		6. Retroactively deny or reduce reimbu rsement for a covered
145	215		service claim after returning a paid claim response as part of the
146	216		adjudication of the claim, unless:
147	217		a. the original claim was submitted fraudulently, or
148	218		b. to correct errors identified in an audit, so long as
149	219		the audit was conducted in compliance with Sections
150	220		356.2 and 356.3 of Title 59 of the Oklahoma Statutes;
151	221		7. Fail to make any payment due to a pharmacy or pharmacist for
152	222		covered services properly re ndered in the event a PBM terminates a
153	223		provider from a pharmacy benefits manager network;
154	224		8. Conduct or practice spread pricing, as defined in Section 1
155	225		6960 of this act title, in this state; or
156	226		9. Charge a pharmacist or pharmacy a fee related to
157	227		participation in a retail pharmacy network including but not limited
158	228		to the following:
159	229		a. an application fee,
160	230		b. an enrollment or participation fee,
161	231		c. a credentialing or re-credentialing fee,
162	232		d. a change of ownership fee, or
163	233		e. a fee for the development or management of claims
164	234		processing services or claims payment services .
165	235		C. The prohibitions under this section shall apply to contracts
166	236		between pharmacy benefits managers and providers for participation
167	237		in retail pharmacy networks.
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195	289		1. A PBM contract shall:
196	290		a. not restrict, directly or indirectly, any pharmacy
197	291		that dispenses a prescription drug from informing, or
198	292		penalize such pharmacy for informing, an indivi dual of
199	293		any differential between the individual’s out-of-
200	294		pocket cost or coverage with respect to acquisition of
201	295		the drug and the amount an individual would pay to
202	296		purchase the drug directly, and
203	297		b. ensure that any entity t hat provides pharmacy benefits
204	298		management services under a contract with any such
205	299		health plan or health insurance coverage does not,
206	300		with respect to such plan or coverage, restrict,
207	301		directly or indirectly, a pharmacy that dispenses a
208	302		prescription drug from inf orming, or penalize such
209	303		pharmacy for informing, a covered individu al of any
210	304		differential between the individual ’s out-of-pocket
211	305		cost under the plan or coverage with respect to
212	306		acquisition of the drug and t he amount an individual
213	307		would pay for acquisit ion of the drug without using
214	308		any health plan or health insurance coverage.
215	309		2. A pharmacy benefits manager ’s contract with a provider shall
216	310		not prohibit, restrict or limit disclosure of information to the
217	311		Attorney General, law enforcement or state and federal governmental
218	312		officials investigating or examining a c omplaint or conducting a
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220		-	SENATE FLOOR VERSION - SB1581 SFLR Page 5
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246	364		review of a pharmacy benefits manager ’s compliance with the
247	365		requirements under the Patient’s Right to Pharmacy Choice Act.
248	366		D. A pharmacy benefits manager shall:
249	367		1. Establish and maintain an elect ronic claim inquiry
250	368		processing system using the National Council for Prescription Drug
251	369		Programs’ current standards to communicate information to pharmacies
252	370		submitting claim inquiries;
253	371		2. Fully disclose to insurer s, self-funded employers, unions or
254	372		other PBM clients the existence of the re spective aggregate
255	373		prescription drug discounts, rebates rece ived from drug
256	374		manufacturers and pharmacy audit recoupments;
257	375		3. Provide the Attorney General, insurers, self-funded employer
258	376		plans and unions unrestricted audi t rights of and access to the
259	377		respective PBM pharmaceutical manufacturer and provider contracts,
260	378		plan utilization data, plan pricing data, pharmacy utilization dat a
261	379		and pharmacy pricing data;
262	380		4. Maintain, for no less than three (3) years, documentation of
263	381		all network development activities including but not limited to
264	382		contract negotiations and any denials to providers to join networks.
265	383		This documentation shall be made available to th e Attorney General
266	384		upon request;
267	385		5. Report to the Attorney General, on a quarterly basis for
268	386		each health insurer payor, on the following information:
269	387		a. the aggregate amount of rebates received by t he PBM,
270	388
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297	439		b. the aggregate amount of rebates distributed to the
298	440		appropriate health in surer payor,
299	441		c. the aggregate amount of rebates passed on to the
300	442		enrollees of each healt h insurer payor at the point of
301	443		sale that reduced the applicable deductible,
302	444		copayment, coinsure or other cost sharing amount of
303	445		the enrollee,
304	446		d. the individual and agg regate amount paid by t he health
305	447		insurer payor to the PBM for pharmacy services
306	448		itemized by pharmacy, drug product and service
307	449		provided, and
308	450		e. the individual and aggreg ate amount a PBM paid a
309	451		provider for pharmac y services itemized by pharmacy,
310	452		drug product and service provide d; and
311	453		6. Maintain a fiduciary duty to insurers and insured s served by
312	454		the PBM.
313	455		SECTION 2. This act shall become effective November 1, 2024.
314		-	~~COMMITTEE REPORT BY: COMMITTEE ON RETIREMENT AND INSURANCE~~
315		-	~~February 13,~~ 2024 ~~- DO PASS~~
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	457	+	59-2-2862 RD 1/8/2024 12:55:51 PM