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SENATE FLOOR VERSION
February 13, 2024
SENATE BILL NO. 1581 By: Hicks of the Senate
and
Marti of the House
An Act relating to pharmacy benefits manage ment;
amending 36 O.S. 2021, Section 6962, as last amended
by Section 1, Chapter 293, O.S.L. 2023 (36 O.S. Supp.
2023, Section 6962), which relates to pharmacy
benefits manager compliance; updating statutory
reference; requiring pharmacy benefits manager to
maintain certain fiduciary duty; and providing an
effective date.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 36 O.S. 2021, Section 6962, as
last amended by Section 1, Chapter 293, O.S.L. 2023 (36 O.S. Supp.
2023, Section 6962), is amended to read as follows:
Section 6962. A. The Attorney General shall review and approve
retail pharmacy network access for all p harmacy benefits managers
(PBMs) to ensure compliance with Sec tion 6961 of this title.
B. A PBM, or an agent of a PBM, shall not:
1. Cause or knowingly permit the use of advertisement,
promotion, solicitation, representation, proposal or offer that is
untrue, deceptive or misleading;
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2. Charge a pharmacist or phar macy a fee related to the
adjudication of a claim including without limitation a fee for:
a. the submission of a claim,
b. enrollment or participation in a retail pharmacy
network, or
c. the development or management of claims processing
services or claims payment services related to
participation in a retail pharmacy network;
3. Reimburse a pharmacy or pharmacist in the state an amount
less than the amount that the PBM reimburses a pharm acy owned by or
under common ownership with a PBM for providing the s ame covered
services. The reimbursement amount paid to the pharmacy shall be
equal to the reimbursement amount calculated on a per-unit basis
using the same generic product identifier or generic code number
paid to the PBM-owned or PBM-affiliated pharmacy;
4. Deny a provider the opportunity to participate in any
pharmacy network at preferred participation status if the provider
is willing to accept the terms and conditions that the PBM has
established for other providers as a condition of preferred networ k
participation status;
5. Deny, limit or terminate a provider’s contract based on
employment status of a ny employee who has an active license to
dispense, despite probation status, wi th the State Board of
Pharmacy;
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6. Retroactively deny or reduce reimbu rsement for a covered
service claim after returning a paid claim response as part of the
adjudication of the claim, unless:
a. the original claim was submitted fraudulently, or
b. to correct errors identified in an audit, so long as
the audit was conducted in compliance with Sections
356.2 and 356.3 of Title 59 of the Oklahoma Statutes;
7. Fail to make any payment due to a pharmacy or pharmacist for
covered services properly re ndered in the event a PBM terminates a
provider from a pharmacy benefits manager network;
8. Conduct or practice spread pricing, as defined in Section 1
6960 of this act title, in this state; or
9. Charge a pharmacist or pharmacy a fee related to
participation in a re tail pharmacy network including but not limited
to the following:
a. an application fee,
b. an enrollment or participation fee,
c. a credentialing or re-credentialing fee,
d. a change of ownership fee, or
e. a fee for the development or management of claims
processing services or claims payment services .
C. The prohibitions under this section shall apply to contracts
between pharmacy benefits managers and providers for participation
in retail pharmacy networks.
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1. A PBM contract shall:
a. not restrict, directly or indirectly, any pharmacy
that dispenses a prescription drug from informing, or
penalize such pharmacy for informing, an indivi dual of
any differential between the individual’s out-of-
pocket cost or coverage with respect to acquisition of
the drug and the amount an individual would pay to
purchase the drug directly, and
b. ensure that any entity t hat provides pharmacy benefits
management services under a contract with any such
health plan or health insurance coverage does not,
with respect to such plan or coverage, restrict,
directly or indirectly, a pharmacy that dispenses a
prescription drug from inf orming, or penalize such
pharmacy for informing, a covered individual of any
differential between the individual ’s out-of-pocket
cost under the plan or coverage with respect to
acquisition of the drug and t he amount an individual
would pay for acquisit ion of the drug without using
any health plan or health insurance coverage.
2. A pharmacy benefits manager ’s contract with a provider shall
not prohibit, restrict or limit disclosure of information to the
Attorney General, law enforcement or state and federal governmental
officials investigating or examining a c omplaint or conducting a
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review of a pharmacy benefits manager ’s compliance with the
requirements under the Patient’s Right to Pharmacy Choice Act.
D. A pharmacy benefits manager shall:
1. Establish and maintain an elect ronic claim inquiry
processing system using the National Council for Prescription Drug
Programs’ current standards to communicate information to pharmacies
submitting claim inquiries;
2. Fully disclose to insurer s, self-funded employers, unions or
other PBM clients the existence of the re spective aggregate
prescription drug discounts, rebates rece ived from drug
manufacturers and pharmacy audit recoupments;
3. Provide the Attorney General, insurers, self-funded employer
plans and unions unrestricted audi t rights of and access to the
respective PBM pharmaceutical manufacturer and provider contracts,
plan utilization data, plan pricing data, pharmacy utilization dat a
and pharmacy pricing data;
4. Maintain, for no less than three (3) years, documentation of
all network development activities including but not limited to
contract negotiations and any denials to providers to join networks.
This documentation shall be made available to th e Attorney General
upon request;
5. Report to the Attorney General, on a quarterly basis for
each health insurer payor, on the following information:
a. the aggregate amount of rebates received by t he PBM,
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b. the aggregate amount of rebates distributed to the
appropriate health in surer payor,
c. the aggregate amount of rebates passed on to the
enrollees of each healt h insurer payor at the point of
sale that reduced the applicable deductible,
copayment, coinsure or other cost sharing amount of
the enrollee,
d. the individual and agg regate amount paid by t he health
insurer payor to the PBM for pharmacy servic es
itemized by pharmacy, drug product and service
provided, and
e. the individual and aggreg ate amount a PBM paid a
provider for pharmac y services itemized by pharmacy,
drug product and service provide d; and
6. Maintain a fiduciary duty to insurers and insured s served by
the PBM.
SECTION 2. This act shall become effective November 1, 2024.
COMMITTEE REPORT BY: COMMITTEE ON RETIREMENT AND INSURANCE
February 13, 2024 - DO PASS