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37 | 40 | | |
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38 | 41 | | An Act relating to prescription drug reimbursement; |
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39 | 42 | | defining term; directing payment of certain co payment |
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40 | 43 | | by insured under certain circumstances; req uiring |
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41 | 44 | | certain health benefit plans to include certain |
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42 | 45 | | provisions in plans to be issued or renewed ; |
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43 | 46 | | providing for codification; and providing an |
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44 | 47 | | effective date. |
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50 | 53 | | BE IT ENACTED BY THE PEOPLE O F THE STATE OF OKLAHOMA: |
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51 | 54 | | SECTION 1. NEW LAW A new section of law to be codified |
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52 | 55 | | in the Oklahoma Statutes as Section 3634.7 of Title 36, unless there |
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53 | 56 | | is created a duplication in numb ering, reads as follows: |
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54 | 57 | | A. As used in this section, “health benefit plan” shall have |
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55 | 58 | | the same meaning as defin ed pursuant to Section 6060.4 of T itle 36 |
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56 | 59 | | of the Oklahoma Statutes. |
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57 | 60 | | B. For any health benefit plan which covers prescription drug |
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58 | 61 | | reimbursement and is issued or renewed on or after the effective |
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59 | 62 | | date of this act, a patient shall only be responsible for the |
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60 | 63 | | payment of the applicable copayment amount listed in the patient’s |
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61 | 64 | | policy when the prescription drug claim satisfies the f ollowing: |
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88 | 92 | | 1. The reimbursemen t rate for the claim does not cover the |
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89 | 93 | | entire cost of the dr ug and any dispensing fees incurred; and |
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90 | 94 | | 2. There is one insurer pr oviding sole reimbursement for the |
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91 | 95 | | claim. |
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92 | 96 | | C. For any health benefit plan which covers prescription drug |
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93 | 97 | | reimbursement and is issued or renewed on or after the effective |
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94 | 98 | | date of this act, when a copayment at the point of sale is the only |
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95 | 99 | | source of payment for the prescription drug, the copa yment shall |
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96 | 100 | | include the cost of the prescr iption drug plus an average cost of |
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97 | 101 | | dispensing as recognized by the pharmaceutical industry. |
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98 | 102 | | SECTION 2. This act shall become effective November 1, 2024. |
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