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SB1030
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Oklahoma Senate Bill SB1030

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Oklahoma 2025 Regular Session

Oklahoma Senate Bill SB1030 Compare Versions

Only one version of the bill is available at this time.

Version 1 (Old)

Version 2 (New)

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53	53		STATE OF OKLAHOMA
54	54
55	55		1st Session of the 60th Legislature (2025)
56	56
57	57		SENATE BILL 1030 By: Howard
58	58
59	59
60	60
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62	62
63	63		AS INTRODUCED
64	64
65	65		An Act relating to prescription drug pricing;
66	66		creating the 340B Drug Pricing Nondiscrimination Act;
67	67		providing short title; defining terms; prohibiting
68	68		certain reimbursement rates; prohibiting certain
69	69		terms or conditions on a 340B entity; prohibiting
70	70		certain interference on certain patient choice;
71	71		prohibiting certain provisions in certain contracts;
72	72		requiring submission of certain cost data; providing
73	73		certain exceptions; prohibiting manufacturers or
74	74		distributors from limiting certain drug actions;
75	75		prohibiting certain contracts; providing for
76	76		promulgation of rules; establishing certain fines or
77	77		fees; providing certain exceptions; amending 36 O.S.
78	78		2021, Sections 6960 and 6962, as last amended by
79	79		Sections 1 and 2, Chapter 306, O.S.L. 2024 (36 O.S.
80	80		Supp. 2024, Sections 6960 and 6962), which relate to
81	81		definitions and compliance review; defining terms;
82	82		prohibiting certain provider requirements;
83	83		prohibiting certain billing modifier; prohibiting
84	84		certain modifications; prohibiting certain provider
85	85		exclusions; prohibiting participation in certain
86	86		networks; prohibiting bas ing certain decisions on
87	87		certain drug pricing; eliminating certain
88	88		contracting; amending Section 3, Chapter 38, O.S.L.
89	89		2022, as last amended by Section 4, Chapter 306,
90	90		O.S.L. 2024 (36 O.S. Supp. 2024, Section 6966.1) ,
91	91		which relates to violations; establishing certain
92	92		finality of certain claims; providing for
93	93		codification; and providi ng an effective date.
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97	97		BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
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149	149		SECTION 1. NEW LAW A new section of law to be codified
150	150		in the Oklahoma Statutes as Section 5400 of Title 36, unless there
151	151		is created a duplication in numbering, reads as follows:
152	152		This act shall be known and may be cited as the “340B Drug
153	153		Pricing Nondiscrimination Act ”.
154	154		SECTION 2. NEW LAW A new sec tion of law to be codified
155	155		in the Oklahoma Statutes as Section 5401 of Title 36 , unless there
156	156		is created a duplication in numbering, reads as follows:
157	157		As used in this act:
158	158		1. “340B drug” means a drug that has been subject to any
159	159		reduced purchase price by a manufacturer pursuant to Section 256b of
160	160		Title 42 of the United States Code and is purchased by a covered
161	161		entity as defined in Section 256b(a)(4) of Title 42 of the United
162	162		States Code;
163	163		2. “340B entity” means an entity participating or authorized to
164	164		participate in the federal 340B drug pricing program, as described
165	165		in Section 256b of Title 42 of the United States Code, including its
166	166		pharmacy, or any pharmacy contracted with the participating entity
167	167		to dispense drugs purchased through the 340B drug pricing program;
168	168		3. “Distributor” means a person other than a manufacturer, a
169	169		manufacturer’s co-licensed partner, a third -party logistics
170	170		provider, or repackager engaged in wholesale distribution as defined
171	171		by Section 353(e)(4) of Title 21 of the United States C ode as
172	172		amended by the Drug Supply Chain Security Act;
173	173
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224	224		4. “Manufacturer” means:
225	225		a. a person that holds an application approved under
226	226		Section 355 of Title 21 of the United States Code or a
227	227		license issued under Section 262 of Title 42 of the
228	228		United States Code for such product, or if such
229	229		product is not the subject of an approved application
230	230		or license, the person who manufactured the product,
231	231		b. a co-licensed partner of the person described in
232	232		subparagraph a of this paragraph that obtains the
233	233		product directly from a person described in this
234	234		subparagraph or subparagraph a of this paragr aph,
235	235		c. an affiliate of a person described in subparagraph a
236	236		or b of this paragraph who receives the product
237	237		directly from a person described in this subparagraph
238	238		or in subparagraph a or b of this paragraph, or
239	239		d. a person who contracts with another to manufacture a
240	240		product;
241	241		5. “Pharmacy” means a pharmacy licensed by the State Board of
242	242		Pharmacy, provided patients who receive pharmacy care shall be
243	243		physically located in the state ; and
244	244		6. “Pharmacy benefits manager ” means a person that performs
245	245		pharmacy benefits management and any other person acting for such
246	246		person under a contractual or employment relationship in the
247	247		performance of pharmacy benefits management for a managed care
248	248
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299	299		company, nonprofit hospital, medical service organization, insurance
300	300		company, third-party payor, or a health program administered by a
301	301		department of this state.
302	302		SECTION 3. NEW LAW A new section of law to be codified
303	303		in the Oklahoma Statutes as Section 5402 of Title 36, unless there
304	304		is created a duplication in numbering, reads as follows:
305	305		A. With respect to reimbursement to a 340B entity for 340B
306	306		drugs, a health insurance issuer, pharmacy benefits manager, other
307	307		third-party payor, or its agent shall not:
308	308		1. Reimburse a 340B entity for 340B drugs at a rate lower than
309	309		that paid for the same drug to entities that are not 340B entities
310	310		or lower reimbursement for a claim on the basis that the claim is
311	311		for a 340B drug;
312	312		2. Impose any terms or conditions on any 340B entity with
313	313		respect to any of the following that di ffer from such terms or
314	314		conditions applied to non -340B entities on the basis that the entity
315	315		participates in the federal 340B drug pricing program set forth in
316	316		Section 256b of Title 42 of the United States Code or that a drug is
317	317		a 340B drug. Such terms and conditions shall include, but not be
318	318		limited to, any of the following:
319	319		a. fees, charges, clawbacks, or other adjustments or
320	320		assessments. For purposes of this subparagraph, th e
321	321		term “other adjustments” includes placing any
322	322		additional requirements, restri ctions, or unnecessary
323	323
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374	374		burdens upon the 340B entity that result in
375	375		administrative costs or fees to the 340B entity that
376	376		are not placed upon other entities that do not
377	377		participate in the 340B drug pricing program,
378	378		including affiliate pharmacies of the health insurance
379	379		issuer, pharmacy benefits manager, or other third -
380	380		party payor,
381	381		b. dispensing fees that are less than the dispensing fees
382	382		for non-340B entities,
383	383		c. restrictions or requirements regarding participation
384	384		in standard or preferred pharmacy networks,
385	385		d. requirements relating to the frequency or scope of
386	386		audits of inventory management systems,
387	387		e. requirements that a claim for a drug include any
388	388		identification, billing modifie r, attestation, or
389	389		other indication that a drug is a 340B drug in order
390	390		to be processed or resubmitted unless it is required
391	391		by the Centers for Medicare and Medicaid Services or
392	392		the Oklahoma Health Care Authority for the
393	393		administration of the Oklahoma Medi caid program, or
394	394		f. any other restrictions, conditions, practice s, or
395	395		policies that are not imposed on non -340B entities;
396	396		3. Require a 340B entity to reverse, resubmit, or clarify a
397	397		claim after the initial adjudication unless these actions are in the
398	398
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449	449		normal course of pharmacy business and not related to 340B drug
450	450		pricing;
451	451		4. Discriminate against a 340B entity in a manner that prevents
452	452		or interferes with any patient ’s choice to receive such drugs from
453	453		the 340B entity, including the administration of such d rugs. For
454	454		purposes of this subsection, it is considered a discriminatory
455	455		practice that prevents or interferes with a patient ’s choice to
456	456		receive drugs at a 340B entity if a health insurance issuer,
457	457		pharmacy benefits manager, or other third -party payor places any
458	458		additional requirements, restrictions, or unnecessary burdens upon
459	459		the 340B entity including, but not limited to, requiring a claim for
460	460		a drug to include any identification, billing modifier, attestation,
461	461		or other indication that a drug is a 340B d rug in order to be
462	462		processed or resubmitted unless it is required by the Center s for
463	463		Medicare and Medicaid Services or the Oklahoma Health Care Authority
464	464		in administration of the Oklahoma Medicaid program;
465	465		5. Include any other provision in a contract betw een a health
466	466		insurance issuer, pharmacy benefits manager, or other third -party
467	467		payor and a 340B entity that discriminates against the 340B entity
468	468		or prevents or interferes with an individual ’s choice to receive a
469	469		prescription drug from 340B entity, includi ng the administration of
470	470		the drug, in person or via direct delivery, mail, or o ther form of
471	471		shipment, or creation of a restriction or additional charge on a
472	472		patient who chooses to receive drugs from a 340B entity;
473	473
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524	524		6. Require or compel the submission of in gredient costs or
525	525		pricing data pertaining to 340B drugs to any health insurance
526	526		issuer, pharmacy benefits manager, or other third -party payor; or
527	527		7. Exclude any 340B entity from the health insurance issuer,
528	528		pharmacy benefits manager, or other third -party payor network on the
529	529		basis that the 340B entity dispenses drugs subject to an a greement
530	530		under Section 256b of Title 42 of the United State Code , or refuse
531	531		to contract with a 340B entity for reasons other than those that
532	532		apply equally to non -340B entities.
533	533		B. Nothing in this section applies to the Oklahoma Medicaid
534	534		program as payor when Medicaid provides reimbursement for covered
535	535		outpatient drugs as defined in Section 1396r -8(k) of Title 42 of the
536	536		United States Code.
537	537		SECTION 4. NEW LAW A new section of law to be codified
538	538		in the Oklahoma Statutes as Section 5403 of Title 36, unless there
539	539		is created a duplication in numbering, reads as follows:
540	540		A manufacturer or distributor shall not:
541	541		1. Deny, prohibit, condition, discriminate against, refuse, or
542	542		withhold 340B drug pricing for, or otherwise limit the dispensing,
543	543		purchase, ordering, delivery, or receipt of, a drug purchased to be
544	544		dispensed or administered under a contract pharmacy agreement; or
545	545		2. Prohibit a pharmacy from contracting or participating with a
546	546		340B entity by denying 340B pricing on, or the pharmacy ’s access to,
547	547
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598	598		a drug that is manufactured by a manufacturer based on a pharmacy ’s
599	599		relationship with a 340B entity.
600	600		SECTION 5. NEW LAW A new section of law to be codified
601	601		in the Oklahoma Statutes as Section 5404 of Title 36, unless there
602	602		is created a duplication in numbering, reads as follows:
603	603		The Attorney General may promulgate rules to effectuate the
604	604		provisions of this act and shall make recommendations to the
605	605		Insurance Commissioner for enforcement within the jurisdiction of
606	606		the Insurance Commissioner. In addition to or in lieu of any
607	607		applicable censure, suspension, or revocation of a license, a
608	608		manufacturer, distributor, health insurance issuer, pharmacy
609	609		benefits manager, other third -party payor, or its agent may be
610	610		subject to a civil fine not less than One Hundred Dollars ($100.00)
611	611		and not greater than Ten Thousand Dollars ($10,000.00) for each
612	612		violation of the provisions of this act. A violation occurs e ach
613	613		time a prohibited act is committed.
614	614		SECTION 6. NEW LAW A new section of law to be codified
615	615		in the Oklahoma Statutes as Section 5405 of Title 36, unless there
616	616		is created a duplication in numbering, reads as follows:
617	617		A. Nothing in this act shall be construed to be less
618	618		restrictive than federal law for a person or entity regulated by
619	619		this act.
620	620		B. Nothing in this act shall be construed to be in conflict
621	621		with applicable federal law and regulations or Oklahoma Statute s.
622	622
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673	673		C. Limited distribution of a drug required under Section 355 -1
674	674		of Title 21 of the United St ates Code shall not be construed as a
675	675		violation of this act.
676	676		SECTION 7. AMENDATORY 36 O.S. 2021, Section 6960, as
677	677		last amended by Section 1, Chapter 30 6, O.S.L. 2024 (36 O.S. Supp.
678	678		2024, Section 6960), is amended to read as follows:
679	679		Section 6960. A. For purposes of the Patient ’s Right to
680	680		Pharmacy Choice Act:
681	681		1. “Covered entity” means a nonprofit hospital or medical
682	682		service organization, for -profit hospital or medical service
683	683		organization, insurer, health benefit plan, health mai ntenance
684	684		organization, health program administered by the state in the
685	685		capacity of providing health coverage, or an employer, labor union,
686	686		or other group of persons that provide s health coverage to persons
687	687		in this state. This term does not include a health plan that
688	688		provides coverage only for accidental injury, specified disease,
689	689		hospital indemnity, disability income, or other limited benefit
690	690		health insurance policies and contra cts that do not include
691	691		prescription drug coverage;
692	692		2. “Health insurer” means any corporation, association, benefit
693	693		society, exchange, partnership or individual licensed by the
694	694		Oklahoma Insurance Code;
695	695		3. “Health insurer payor ” means a health insurance c ompany,
696	696		health maintenance organization, union, hospital and medical
697	697
698	698
699	699		Req. No. 596 Page 10 1
700	700		2
701	701		3
702	702		4
703	703		5
704	704		6
705	705		7
706	706		8
707	707		9
708	708		10
709	709		11
710	710		12
711	711		13
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714	714		16
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717	717		19
718	718		20
719	719		21
720	720		22
721	721		23
722	722		24
723	723		1
724	724		2
725	725		3
726	726		4
727	727		5
728	728		6
729	729		7
730	730		8
731	731		9
732	732		10
733	733		11
734	734		12
735	735		13
736	736		14
737	737		15
738	738		16
739	739		17
740	740		18
741	741		19
742	742		20
743	743		21
744	744		22
745	745		23
746	746		24
747	747
748	748		services organization or any entity providing or administering a
749	749		self-funded health benefit plan;
750	750		4. “Mail-order pharmacy” means a pharmacy licensed by this
751	751		state that primarily dispense s and delivers covered drugs via common
752	752		carrier;
753	753		5. “Pharmacy benefits manager ” or “PBM” means a person,
754	754		business, or other entity that performs pharmacy benefits
755	755		management. The term shall include a person or entity acting on
756	756		behalf of a PBM in a contra ctual or employment relationship in the
757	757		performance of pharmacy benefits management for a managed care
758	758		company, nonprofit hospital, medical service organization, insurance
759	759		company, third-party payor or a health program administered by a
760	760		department of this state;
761	761		6. “Pharmacy benefits management ” means a service provided to
762	762		covered entities to facilitate the provisions of prescription drug
763	763		benefits to covered individuals within the state, including, but not
764	764		limited to, negotiating pricing and other terms wi th drug
765	765		manufacturers and providers. Pharmacy benefits management may
766	766		include any or all of the following services:
767	767		a. claims processing, retail network management, and
768	768		payment of claims to pharmacies for prescription drugs
769	769		dispensed to covered individual s,
770	770		b. administration or management of pharmacy discount
771	771		cards or programs,
772	772
773	773
774	774		Req. No. 596 Page 11 1
775	775		2
776	776		3
777	777		4
778	778		5
779	779		6
780	780		7
781	781		8
782	782		9
783	783		10
784	784		11
785	785		12
786	786		13
787	787		14
788	788		15
789	789		16
790	790		17
791	791		18
792	792		19
793	793		20
794	794		21
795	795		22
796	796		23
797	797		24
798	798		1
799	799		2
800	800		3
801	801		4
802	802		5
803	803		6
804	804		7
805	805		8
806	806		9
807	807		10
808	808		11
809	809		12
810	810		13
811	811		14
812	812		15
813	813		16
814	814		17
815	815		18
816	816		19
817	817		20
818	818		21
819	819		22
820	820		23
821	821		24
822	822
823	823		c. clinical formulary development and management
824	824		services, or
825	825		d. rebate contracting and administration;
826	826		7. “Provider” means a pharmacy, as defined in Section 353.1 of
827	827		Title 59 of the Oklahoma Statutes or an agent or representative of a
828	828		pharmacy;
829	829		8. “Retail pharmacy network ” means retail pharmacy providers
830	830		contracted with a PBM in which the pharmacy primarily fills and
831	831		sells prescriptions via a retail, storefront location;
832	832		9. “Rural service area” means a five-digit ZIP code in which
833	833		the population density is less than one thousand (1,000) individuals
834	834		per square mile;
835	835		10. “Spread pricing” means a prescription drug pricing model
836	836		utilized by a pharmacy benefits manager in which the PB M charges a
837	837		health benefit plan a contracted price for prescription drugs that
838	838		differs from the amount the PBM directly or indirectly pays the
839	839		pharmacy or pharmacist for providing pharmacy services;
840	840		11. “Suburban service area ” means a five-digit ZIP code in
841	841		which the population density is between one thousand (1,000) and
842	842		three thousand (3,000) individuals per square mile; and
843	843		12. “Urban service area” means a five-digit ZIP code in which
844	844		the population density is greater than three thousand (3,000)
845	845		individuals per square mile ;
846	846
847	847
848	848		Req. No. 596 Page 12 1
849	849		2
850	850		3
851	851		4
852	852		5
853	853		6
854	854		7
855	855		8
856	856		9
857	857		10
858	858		11
859	859		12
860	860		13
861	861		14
862	862		15
863	863		16
864	864		17
865	865		18
866	866		19
867	867		20
868	868		21
869	869		22
870	870		23
871	871		24
872	872		1
873	873		2
874	874		3
875	875		4
876	876		5
877	877		6
878	878		7
879	879		8
880	880		9
881	881		10
882	882		11
883	883		12
884	884		13
885	885		14
886	886		15
887	887		16
888	888		17
889	889		18
890	890		19
891	891		20
892	892		21
893	893		22
894	894		23
895	895		24
896	896
897	897		13. “340B drug” means a drug that has been subject to any
898	898		reduced purchase price by a manufacturer pursuant to Section 256b of
899	899		Title 42 of the United States Code and is purchased by a covered
900	900		entity as defined in Section 256b(a)(4) o f Title 42 of the United
901	901		States Code; and
902	902		14. “340B entity” means an entity pa rticipating or authorized
903	903		to participate in the federal 340B drug pricing program, as
904	904		described in Section 256b of Title 42 of the United States Code,
905	905		including its pharmacy, or any pharmacy contracted with the
906	906		participating entity to dispense drugs purchased through the 340B
907	907		drug pricing program .
908	908		B. Nothing in the definitions of pharmacy benefits manager or
909	909		pharmacy benefits management as such terms are defined in the
910	910		Patient’s Right to Pharmacy Choice Act, the Pharmacy Audit Integrity
911	911		Act, or Sections 357 through 360 of Title 59 of the Oklahoma
912	912		Statutes shall be construed to deem the following entities to be a
913	913		pharmacy benefits manager:
914	914		1. An employer of its own self -funded health benefit plan,
915	915		except, to the extent permitted by applicable law, where the
916	916		employer without the utilization of a third party and unrelated to
917	917		the employer’s own pharmacy:
918	918		a. negotiates directly with drug manufacturers,
919	919		b. processes claims on behalf of its members, or
920	920		c. manages its own retail network of pharmacies; or
921	921
922	922
923	923		Req. No. 596 Page 13 1
924	924		2
925	925		3
926	926		4
927	927		5
928	928		6
929	929		7
930	930		8
931	931		9
932	932		10
933	933		11
934	934		12
935	935		13
936	936		14
937	937		15
938	938		16
939	939		17
940	940		18
941	941		19
942	942		20
943	943		21
944	944		22
945	945		23
946	946		24
947	947		1
948	948		2
949	949		3
950	950		4
951	951		5
952	952		6
953	953		7
954	954		8
955	955		9
956	956		10
957	957		11
958	958		12
959	959		13
960	960		14
961	961		15
962	962		16
963	963		17
964	964		18
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966	966		20
967	967		21
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969	969		23
970	970		24
971	971
972	972		2. A pharmacy that provides a patient with a discount card or
973	973		program that is for exclusive use at the pharmacy offering the
974	974		discount.
975	975		SECTION 8. AMENDATORY 36 O.S. 2021, Section 6962, as
976	976		last amended by Section 2, Chapter 306, O.S.L. 2024 (36 O.S. Supp.
977	977		2024, Section 6962), is amended to read as follows:
978	978		Section 6962. A. The Attorney General shall review and approve
979	979		retail pharmacy network access for all pharm acy benefits managers
980	980		(PBMs) to ensure compliance with Section 6961 of this tit le.
981	981		B. A PBM, or an agent of a PBM, shall not:
982	982		1. Cause or knowingly permit the use of advertisement,
983	983		promotion, solicitation, representation, proposal or offer that is
984	984		untrue, deceptive or misleading;
985	985		2. Charge a pharmacist or pharmacy a fee related to the
986	986		adjudication of a claim including without limitation a fee for:
987	987		a. the submission of a claim,
988	988		b. enrollment or participation in a retail pharmacy
989	989		network, or
990	990		c. the development or management of claims processing
991	991		services or claims payment services rel ated to
992	992		participation in a retail pharmacy network;
993	993		3. Reimburse a pharmacy or pharmacist in the state an amount
994	994		less than the amount that the PBM reimburses a pharmacy owned b y or
995	995		under common ownership with a PBM for providing the same covered
996	996
997	997
998	998		Req. No. 596 Page 14 1
999	999		2
1000	1000		3
1001	1001		4
1002	1002		5
1003	1003		6
1004	1004		7
1005	1005		8
1006	1006		9
1007	1007		10
1008	1008		11
1009	1009		12
1010	1010		13
1011	1011		14
1012	1012		15
1013	1013		16
1014	1014		17
1015	1015		18
1016	1016		19
1017	1017		20
1018	1018		21
1019	1019		22
1020	1020		23
1021	1021		24
1022	1022		1
1023	1023		2
1024	1024		3
1025	1025		4
1026	1026		5
1027	1027		6
1028	1028		7
1029	1029		8
1030	1030		9
1031	1031		10
1032	1032		11
1033	1033		12
1034	1034		13
1035	1035		14
1036	1036		15
1037	1037		16
1038	1038		17
1039	1039		18
1040	1040		19
1041	1041		20
1042	1042		21
1043	1043		22
1044	1044		23
1045	1045		24
1046	1046
1047	1047		services. The reimbursement amount paid to the pharmacy shall be
1048	1048		equal to the reimbursement amount calculated on a per -unit basis
1049	1049		using the same generic product identifier or generic co de number
1050	1050		paid to the PBM-owned or PBM-affiliated pharmacy;
1051	1051		4. Deny a provider the opportunity to participate in any
1052	1052		pharmacy network at preferred participation status if the provider
1053	1053		is willing to accept the terms and conditions that the PBM has
1054	1054		established for other providers as a condition of preferred network
1055	1055		participation status;
1056	1056		5. Deny, limit or terminate a provider ’s contract based on
1057	1057		employment status of any employee who has an active license to
1058	1058		dispense, despite probation status, with the State Board of
1059	1059		Pharmacy;
1060	1060		6. Retroactively deny or reduce reimbursement for a covered
1061	1061		service claim after returning a paid claim response as part of the
1062	1062		adjudication of the claim, unless:
1063	1063		a. the original claim was submitted fraudulently, or
1064	1064		b. to correct errors identified in an audit, so long as
1065	1065		the audit was conducted in compliance with Sections
1066	1066		356.2 and 356.3 of Title 59 of the Oklahoma Statutes;
1067	1067		7. Fail to make any payment due to a pharmacy or pharmacist for
1068	1068		covered services properly rendered in the event a PBM terminates a
1069	1069		provider from a pharmacy benefits manager network;
1070	1070
1071	1071
1072	1072		Req. No. 596 Page 15 1
1073	1073		2
1074	1074		3
1075	1075		4
1076	1076		5
1077	1077		6
1078	1078		7
1079	1079		8
1080	1080		9
1081	1081		10
1082	1082		11
1083	1083		12
1084	1084		13
1085	1085		14
1086	1086		15
1087	1087		16
1088	1088		17
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1090	1090		19
1091	1091		20
1092	1092		21
1093	1093		22
1094	1094		23
1095	1095		24
1096	1096		1
1097	1097		2
1098	1098		3
1099	1099		4
1100	1100		5
1101	1101		6
1102	1102		7
1103	1103		8
1104	1104		9
1105	1105		10
1106	1106		11
1107	1107		12
1108	1108		13
1109	1109		14
1110	1110		15
1111	1111		16
1112	1112		17
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1114	1114		19
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1116	1116		21
1117	1117		22
1118	1118		23
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1120	1120
1121	1121		8. Conduct or practice spread pricing, as defined in Section
1122	1122		6960 of this title, in this state; or
1123	1123		9. Charge a pharmacist or pharmacy a fee related to
1124	1124		participation in a retail pharmacy network including but not limited
1125	1125		to the following:
1126	1126		a. an application fee,
1127	1127		b. an enrollment or participation fee,
1128	1128		c. a credentialing or re -credentialing fee,
1129	1129		d. a change of ownership fee, or
1130	1130		e. a fee for the development or management of claims
1131	1131		processing services or claims payment services ;
1132	1132		10. Discriminate, offer lower reimbursemen t, or impose any
1133	1133		separate terms upon a provider on the basis that a provider
1134	1134		participates in 340B drug pricing;
1135	1135		11. Require a provider to reverse, resubmit, or clarify a 340B
1136	1136		drug pricing claim after the initial adjudication unless these
1137	1137		actions are in normal course of pharmacy business and not related to
1138	1138		340B drug pricing;
1139	1139		12. Require a billing modifier to indicate that the drug or
1140	1140		claim is a 340B drug pricing claim, unless th e drug or claim is
1141	1141		being billed to the Oklahoma Medicaid program;
1142	1142		13. Modify a patient copayment on the basis that the provider
1143	1143		of the patient participates in 340B drug pricing;
1144	1144
1145	1145
1146	1146		Req. No. 596 Page 16 1
1147	1147		2
1148	1148		3
1149	1149		4
1150	1150		5
1151	1151		6
1152	1152		7
1153	1153		8
1154	1154		9
1155	1155		10
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1164	1164		19
1165	1165		20
1166	1166		21
1167	1167		22
1168	1168		23
1169	1169		24
1170	1170		1
1171	1171		2
1172	1172		3
1173	1173		4
1174	1174		5
1175	1175		6
1176	1176		7
1177	1177		8
1178	1178		9
1179	1179		10
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1181	1181		12
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1183	1183		14
1184	1184		15
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1190	1190		21
1191	1191		22
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1194	1194
1195	1195		14. Exclude a provider from a network on the basis that the
1196	1196		provider participates in 340B drug pricing;
1197	1197		15. Establish or set network adequacy requirements based on
1198	1198		340B drug pricing participation by a provider;
1199	1199		16. Prohibit a 340B entity or a pharmacy under contract with a
1200	1200		340B entity from participating in the network of the PBM on the
1201	1201		basis of participation in 340B drug pricing; or
1202	1202		17. Base the drug form ulary or drug coverage decisions upon the
1203	1203		340B drug pricing status of a drug, including price or availability,
1204	1204		or whether a dispensing pharmacy participates in 340B drug pricing .
1205	1205		C. The prohibitions under this section shall apply to contracts
1206	1206		between pharmacy benefits managers and providers for participation
1207	1207		in retail pharmacy networks.
1208	1208		1. A PBM contract shall:
1209	1209		a. not restrict, directly or indirectly, any pharmacy
1210	1210		that dispenses a prescription drug from informing, or
1211	1211		penalize such pharmacy for informing, an individual of
1212	1212		any differential between the individual ’s out-of-
1213	1213		pocket cost or coverage with respect to acquisition of
1214	1214		the drug and the amount an individual would pay to
1215	1215		purchase the drug directly, and
1216	1216		b. ensure that any entity that provides pharmacy benefits
1217	1217		management services under a contract with any such
1218	1218		health plan or health insurance coverage does not,
1219	1219
1220	1220
1221	1221		Req. No. 596 Page 17 1
1222	1222		2
1223	1223		3
1224	1224		4
1225	1225		5
1226	1226		6
1227	1227		7
1228	1228		8
1229	1229		9
1230	1230		10
1231	1231		11
1232	1232		12
1233	1233		13
1234	1234		14
1235	1235		15
1236	1236		16
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1238	1238		18
1239	1239		19
1240	1240		20
1241	1241		21
1242	1242		22
1243	1243		23
1244	1244		24
1245	1245		1
1246	1246		2
1247	1247		3
1248	1248		4
1249	1249		5
1250	1250		6
1251	1251		7
1252	1252		8
1253	1253		9
1254	1254		10
1255	1255		11
1256	1256		12
1257	1257		13
1258	1258		14
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1266	1266		22
1267	1267		23
1268	1268		24
1269	1269
1270	1270		with respect to such plan or coverage, restrict,
1271	1271		directly or indirect ly, a pharmacy that dispenses a
1272	1272		prescription drug from informing, or penalize s uch
1273	1273		pharmacy for informing, a covered individual of any
1274	1274		differential between the individual ’s out-of-pocket
1275	1275		cost under the plan or coverage with respect to
1276	1276		acquisition of the dr ug and the amount an individual
1277	1277		would pay for acquisition of the drug without using
1278	1278		any health plan or health insurance coverage ., and
1279	1279		c. eliminate discriminatory contracting as it relates to:
1280	1280		(1) transferring the benefit of 340B drug pricing
1281	1281		savings from a 340B entity to another entity,
1282	1282		including without limitation pharmacy benefits
1283	1283		managers, private insurers, and managed care
1284	1284		organizations,
1285	1285		(2) offering a lower reimbursement rate for drugs
1286	1286		purchased under 340B drug pricing than for the
1287	1287		same drug not purchased under 340B drug pricing,
1288	1288		(3) refusal to cover drug purchases utilizing 340B
1289	1289		drug pricing,
1290	1290		(4) refusal to allow providers who utilize 340B drug
1291	1291		pricing to participate in networks, and
1292	1292
1293	1293
1294	1294		Req. No. 596 Page 18 1
1295	1295		2
1296	1296		3
1297	1297		4
1298	1298		5
1299	1299		6
1300	1300		7
1301	1301		8
1302	1302		9
1303	1303		10
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1318	1318		1
1319	1319		2
1320	1320		3
1321	1321		4
1322	1322		5
1323	1323		6
1324	1324		7
1325	1325		8
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1327	1327		10
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1329	1329		12
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1340	1340		23
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1342	1342
1343	1343		(5) charging more than fair market value or seeking
1344	1344		profit sharing in exchange for services involving
1345	1345		340B drug pricing.
1346	1346		2. A pharmacy benefits ma nager’s contract with a provider shall
1347	1347		not prohibit, restrict, or limit disclosure of information or
1348	1348		documents to the Attorney General, law enforcement or state and
1349	1349		federal governmental officials investigating or examining a
1350	1350		complaint or conducting a review of a pharmacy benefits manager ’s
1351	1351		compliance with the requirements under the Patient ’s Right to
1352	1352		Pharmacy Choice Act, the Pharmacy Audit Integrity Act, and Sections
1353	1353		357 through 360 of Title 59 of the Oklahoma Statutes.
1354	1354		D. A pharmacy benefits manager shall :
1355	1355		1. Establish and maintain an electronic claim inquiry
1356	1356		processing system using the National Council for Prescription Drug
1357	1357		Programs’ current standards to communicate informatio n to pharmacies
1358	1358		submitting claim inquiries;
1359	1359		2. Fully disclose to insurers, self -funded employers, unions or
1360	1360		other PBM clients the existence of the respective aggregate
1361	1361		prescription drug discounts, rebates received from drug
1362	1362		manufacturers and pharmacy audi t recoupments;
1363	1363		3. Provide the Attorney General, insurers, self -funded employer
1364	1364		plans and unions unrestricted audit rights of and access to the
1365	1365		respective PBM pharmaceutical manufacturer and provider contracts,
1366	1366
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1368	1368		Req. No. 596 Page 19 1
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1417	1417		plan utilization data, plan pricing data, pha rmacy utilization data
1418	1418		and pharmacy pricing data;
1419	1419		4. Maintain, for no less than three (3) years, documentation of
1420	1420		all network development activities including but not limited to
1421	1421		contract negotiations and any denials to providers to join networks.
1422	1422		This documentation shall be made available to the Attorney General
1423	1423		upon request; and
1424	1424		5. Report to the Attorney General, on a quarterly basis for
1425	1425		each health insurer payor, on the following information:
1426	1426		a. the aggregate amount of rebates received by the PBM,
1427	1427		b. the aggregate amount of rebates distributed to the
1428	1428		appropriate health insurer payor,
1429	1429		c. the aggregate amount of rebates passed on to the
1430	1430		enrollees of each health insurer payor at the point of
1431	1431		sale that reduced the applicable deductible,
1432	1432		copayment, coinsure or other cost sharing amount of
1433	1433		the enrollee,
1434	1434		d. the individual and aggregate a mount paid by the health
1435	1435		insurer payor to the PBM for pharmacy services
1436	1436		itemized by pharmacy, drug product and service
1437	1437		provided, and
1438	1438		e. the individual and aggregate amount a PBM paid a
1439	1439		provider for pharmacy services itemized by pharmacy,
1440	1440		drug product and service provided ; and
1441	1441
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1492	1492		6. Make drug formulary and coverage decisions based on the
1493	1493		normal course of business of the PBM, not based upon the 340B drug
1494	1494		pricing status of a drug, inc luding price or availability, or
1495	1495		whether a dispensing pharmacy participates in 340B drug pricing.
1496	1496		E. Nothing in the Patient ’s Right to Pharmacy Choice Act shall
1497	1497		prohibit the Attorney General from requesting and obtaining detailed
1498	1498		data, including raw data, in response to the information provided by
1499	1499		a PBM in the quarterly reports required by this section. The
1500	1500		Attorney General may alter the frequency of the reports required by
1501	1501		this section at his or her sole discretion.
1502	1502		F. The Attorney General may promulgat e rules to implement the
1503	1503		provisions of the Patient ’s Right to Pharmacy Choice A ct, the
1504	1504		Pharmacy Audit Integrity Act, and Sections 357 through 360 of Title
1505	1505		59 of the Oklahoma Statutes.
1506	1506		SECTION 9. AMENDATORY Section 3, Chapter 38, O .S.L.
1507	1507		2022, as last amended by Section 4, Chapter 306, O.S.L. 2024 (36
1508	1508		O.S. Supp. 2024, Section 6966.1), is amended to read as follows:
1509	1509		Section 6966.1. A. The Insurance Commissioner may censure,
1510	1510		suspend, revoke, or refuse to issue or renew a license of o r levy a
1511	1511		civil penalty against any person licensed under the insurance laws
1512	1512		of this state for any violation of the Patient ’s Right to Pharmacy
1513	1513		Choice Act, Section 6958 et seq. of this title.
1514	1514		B. 1. If the Attorney General finds, after notice and
1515	1515		opportunity for hearing, that a pharmacy benefits manager (PBM)
1516	1516
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1567	1567		violated one or more provisions of the Patient ’s Right to Pharmacy
1568	1568		Choice Act, the Pharmacy Audit Integrity Act or the provisions of
1569	1569		Sections 357 through 360 of Title 59 of the Oklahoma Statutes, the
1570	1570		Attorney General may instruct the Insurance Commissioner that the
1571	1571		PBM be censured or his or her license be suspended or revoked. If
1572	1572		the Attorney General makes such instruction, the Commissioner shall
1573	1573		enforce such action within thirty (30) days.
1574	1574		2. In addition to or in lieu of any censure or suspension or
1575	1575		revocation of a license by the Commissioner, the Attorney General
1576	1576		may levy a civil or administrative fine not less than One Hundred
1577	1577		Dollars ($100.00) and not greater than Ten Thousand Dollars
1578	1578		($10,000.00) for each violation of the provisions of the Patient ’s
1579	1579		Right to Pharmacy Choice Act, the Pharmacy Audit Integrity Act or
1580	1580		the provisions of Sections 357 through 360 of Title 59 of the
1581	1581		Oklahoma Statutes.
1582	1582		3. The Attorney General may order restitution for econ omic loss
1583	1583		suffered by pharmacies or patients for violations of the Patient ’s
1584	1584		Right to Pharmacy Choice Act, the Pharmacy Audit Integrity Act, or
1585	1585		the provisions of Sections 357 through 360 of Title 59 of the
1586	1586		Oklahoma Statutes.
1587	1587		C. Notwithstanding whether the license of a PBM has been
1588	1588		issued, suspended, revoked, surrendered or lapsed by operation of
1589	1589		law, the Attorney General is hereby authorized to enforce the
1590	1590		provisions of the Patient ’s Right to Pharmacy Choice Act and impose
1591	1591
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1593	1593		Req. No. 596 Page 22 1
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1642	1642		any penalty or remedy authorized under the act against a PBM under
1643	1643		investigation for or charged with a violation of the Patient ’s Right
1644	1644		to Pharmacy Choice Act, the Pharmacy Audit Integrity Act, the
1645	1645		provisions of Sections 357 through 360 of Title 59 of the Oklahoma
1646	1646		Statutes or any provisio n of the insurance laws of this state.
1647	1647		D. Each day that a PBM conducts busines s in this state without
1648	1648		a license from the Insurance Department shall be deemed a violation
1649	1649		of the Patient’s Right to Pharmacy Choice Act.
1650	1650		E. 1. All hearings conducted by the Office of the Attorney
1651	1651		General pursuant to this section shall be public and held in
1652	1652		accordance with the Administrative Procedures Act.
1653	1653		2. Hearings shall be held at the Office of the Attorney General
1654	1654		or any other place the Attorney General may deem conveni ent.
1655	1655		3. The Attorney General, upon written request from a PBM
1656	1656		affected by the hearing, shall cause a full stenographic record of
1657	1657		the proceedings to be made by a competent court reporter. This
1658	1658		record shall be at the expense of the PBM.
1659	1659		4. The ordinary fees and costs of the hearing examiner
1660	1660		appointed pursuant to Section 319 of this title may be assessed by
1661	1661		the hearing examiner against the respondent unless the respondent is
1662	1662		the prevailing party.
1663	1663		F. Any PBM whose license has been censured, suspended, revok ed
1664	1664		or denied renewal or who has had a fine levied against him or her
1665	1665		shall have the right of appeal from the final order of the Attorney
1666	1666
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1668	1668		Req. No. 596 Page 23 1
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1717	1717		General, pursuant to Section 318 et seq. of Title 75 of the Oklahoma
1718	1718		Statutes.
1719	1719		G. If the Attorney General determines, based upon an
1720	1720		investigation of complaints, that a PBM has engaged in violations of
1721	1721		the provisions of the Patient ’s Right to Pharmacy Choice Act, the
1722	1722		Pharmacy Audit Integrity Act, and Sections 357 through 360 of Title
1723	1723		59 of the Oklahoma Statutes with such f requency as to indicate a
1724	1724		general business practice, and that the PBM should be subjected to
1725	1725		closer supervision with respect to those practices, the Attorney
1726	1726		General may require the PBM to file a report at any periodic
1727	1727		interval the Attorney General deems n ecessary.
1728	1728		H. 1. The Attorney General shall have the authority to collect
1729	1729		all fines, penalties, restitution, and interest thereon pursuant to
1730	1730		the provisions of the Patient ’s Right to Pharmacy Choice Act, the
1731	1731		Pharmacy Audit Integrity Act, and the provision s of Sections 357
1732	1732		through 360 of Title 59 of the Oklahoma Statutes, or any othe r
1733	1733		charge, cause of action, prelitigation settlement, or other
1734	1734		settlement that requires the recovery of money as a result of
1735	1735		violations of the Patient ’s Right to Pharmacy Choice Act. Funds
1736	1736		collected by the Attorney General pursuant to the Patient ’s Right to
1737	1737		Pharmacy Choice Act, the Pharmacy Audit Integrity Act, and Sections
1738	1738		357 through 360 of Title 59 of the Oklahoma Statutes shall be
1739	1739		deposited into the Attorney General ’s Pharmacy Benefits Manager
1740	1740		Enforcement Revolving Fund created in Section 5 of this act.
1741	1741
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1792	1792		2. Costs of investigation, litigation, attorney fees, and other
1793	1793		expenses incurred shall be retained by the Office of the Attorney
1794	1794		General. Remaining funds shall be distribute d to pharmacists,
1795	1795		patients, or other injured parties as determined by the Attorney
1796	1796		General.
1797	1797		3. The Attorney General shall promulgate rules for the
1798	1798		distribution of funds pursuant to this subsection.
1799	1799		I. All claims processed by a PBM on behalf of a provider that
1800	1800		participates in 340B drug pricing or on behalf of a 340B entity
1801	1801		shall be deemed final at the point of adjudication.
1802	1802		SECTION 10. This act shall become effective November 1, 2025.
1803	1803
1804	1804		60-1-596 CAD 1/16/2025 2:29:23 PM