Old	New	Differences
1	1
2	2
3	3
4	4	Req. No. 679 Page 1 1
5	5	2
6	6	3
7	7	4
8	8	5
9	9	6
10	10	7
11	11	8
12	12	9
13	13	10
14	14	11
15	15	12
16	16	13
17	17	14
18	18	15
19	19	16
20	20	17
21	21	18
22	22	19
23	23	20
24	24	21
25	25	22
26	26	23
27	27	24
28	28	1
29	29	2
30	30	3
31	31	4
32	32	5
33	33	6
34	34	7
35	35	8
36	36	9
37	37	10
38	38	11
39	39	12
40	40	13
41	41	14
42	42	15
43	43	16
44	44	17
45	45	18
46	46	19
47	47	20
48	48	21
49	49	22
50	50	23
51	51	24
52	52
53	53	STATE OF OKLAHOMA
54	54
55	55	1st Session of the 60th Legislature (2025)
56	56
57	57	SENATE BILL 34 By: Hicks
58	58
59	59
60	60
61	61
62	62
63	63	AS INTRODUCED
64	64
65	65	An Act relating to prescription drugs; creating the
66	66	Access to Lifesaving Medicines Act; providing short
67	67	title; defining terms; prohibiting certain insurers
68	68	and pharmacy benefits managers from imposing certain
69	69	costs; requiring certain rebates be offered to
70	70	certain health benefit plans; establishing terms of
71	71	prescription drug cost sharing; directing
72	72	promulgation of rules; providing for noncodif ication;
73	73	providing for codification; and providing an
74	74	effective date.
75	75
76	76
77	77
78	78
79	79	BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
80	80	SECTION 1. NEW LAW A new section of law not to be
81	81	codified in the Oklahoma Statutes reads as fol lows:
82	82	This act shall be known and may be cited as the “Access to
83	83	Lifesaving Medicines Act ”.
84	84	SECTION 2. NEW LAW A new section of law to be codified
85	85	in the Oklahoma Statutes as Section 697 0 of Title 36, unless there
86	86	is created a duplication in numbering, reads as follows:
87	87	As used in this section:
88	88	1. “Adjusted out-of-pocket amount” means the copayment,
89	89	coinsurance, or other cost -sharing obligation that a health benefit
90	90
91	91
92	92	Req. No. 679 Page 2 1
93	93	2
94	94	3
95	95	4
96	96	5
97	97	6
98	98	7
99	99	8
100	100	9
101	101	10
102	102	11
103	103	12
104	104	13
105	105	14
106	106	15
107	107	16
108	108	17
109	109	18
110	110	19
111	111	20
112	112	21
113	113	22
114	114	23
115	115	24
116	116	1
117	117	2
118	118	3
119	119	4
120	120	5
121	121	6
122	122	7
123	123	8
124	124	9
125	125	10
126	126	11
127	127	12
128	128	13
129	129	14
130	130	15
131	131	16
132	132	17
133	133	18
134	134	19
135	135	20
136	136	21
137	137	22
138	138	23
139	139	24
140	140
141	141	plan requires an insured to pay at the point of sale for a covered
142	142	prescription medication otherwise payable, less the pro rata portion
143	143	of any discounts, rebates, and price concessions in connection with
144	144	the prescription drug;
145	145	2. “Claim” means any bill, claim, or proof of loss made by or
146	146	on behalf of an insured or a prov ider to a health insurer or its
147	147	intermediary, administrator, or representativ e, with which the
148	148	provider has a provider contract for payment for health care
149	149	services under any health benefit plan;
150	150	3. “Excess cost burden” means any copayments, coinsurance, or
151	151	other cost-sharing an insured is required to pay at the point of
152	152	sale to receive a prescription drug or device that exceeds the
153	153	health insurer’s or pharmacy benefits manager ’s net cost after
154	154	applying a pro rata portion of any discounts, rebates, or
155	155	concessions received from manufacturers, pharmacies, or other third
156	156	parties;
157	157	4. “Health benefit plan” means a health benefit plan as defined
158	158	pursuant to Section 6060.4 of Title 36 of the Oklahoma Statutes;
159	159	5. “Health care provider ” or “provider” means a health care
160	160	provider as defined pursuant to Section 3090.2 of Title 63 of the
161	161	Oklahoma Statutes;
162	162	6. “Health insurer” means any entity subject to the
163	163	jurisdiction of the Insurance Department and the insurance laws and
164	164	regulations of this state that contracts o r offers to contract to
165	165
166	166
167	167	Req. No. 679 Page 3 1
168	168	2
169	169	3
170	170	4
171	171	5
172	172	6
173	173	7
174	174	8
175	175	9
176	176	10
177	177	11
178	178	12
179	179	13
180	180	14
181	181	15
182	182	16
183	183	17
184	184	18
185	185	19
186	186	20
187	187	21
188	188	22
189	189	23
190	190	24
191	191	1
192	192	2
193	193	3
194	194	4
195	195	5
196	196	6
197	197	7
198	198	8
199	199	9
200	200	10
201	201	11
202	202	12
203	203	13
204	204	14
205	205	15
206	206	16
207	207	17
208	208	18
209	209	19
210	210	20
211	211	21
212	212	22
213	213	23
214	214	24
215	215
216	216	provide, deliver, arrange for, pay for, or reimburse any of the
217	217	costs of health care services including , but not limited to, a
218	218	health maintenance organization, a health benefit plan, or any other
219	219	entity providing a plan of health in surance, health benefits, or
220	220	health care services;
221	221	7. “Maximum allowable claim ” means the amount the health
222	222	insurer or pharmacy benefits manager has agreed to pay a pharmacy;
223	223	8. “Maximum allowable cost ” means the maximum dollar amount
224	224	that a health insurer or its intermediary will reimburse a pharmacy
225	225	provider for a group of drug s rated as “A”, “AB”, “NR”, or “NA” in
226	226	the most recent edition of the Approved Drug Products with
227	227	Therapeutic Equivalence Evaluations, published by the United States
228	228	Food and Drug Administration, or similarly rated by a nationally
229	229	recognized reference;
230	230	9. “Pharmacy” means a pharmacy as defined pursuant to Section
231	231	353.1 of Title 59 of the Oklahoma Statutes;
232	232	10. “Pharmacy benefits manager ” means a pharmacy benefits
233	233	manager as defined pursuant to Section 6960 of Title 36 of the
234	234	Oklahoma Statutes;
235	235	11. “Point of sale” means the transaction in which goods or
236	236	services including, but not limited to, prescription medications,
237	237	medical devices, and medical supplies are sold to the consumer;
238	238	12. “Rebate” means:
239	239
240	240
241	241	Req. No. 679 Page 4 1
242	242	2
243	243	3
244	244	4
245	245	5
246	246	6
247	247	7
248	248	8
249	249	9
250	250	10
251	251	11
252	252	12
253	253	13
254	254	14
255	255	15
256	256	16
257	257	17
258	258	18
259	259	19
260	260	20
261	261	21
262	262	22
263	263	23
264	264	24
265	265	1
266	266	2
267	267	3
268	268	4
269	269	5
270	270	6
271	271	7
272	272	8
273	273	9
274	274	10
275	275	11
276	276	12
277	277	13
278	278	14
279	279	15
280	280	16
281	281	17
282	282	18
283	283	19
284	284	20
285	285	21
286	286	22
287	287	23
288	288	24
289	289
290	290	a. negotiated price concessions including , but not
291	291	limited to, base rebates and reasonable estimates of
292	292	any price protection rebates and performance -based
293	293	rebates that may accrue, directly or indirectly, to
294	294	the health insurer or pharm acy benefits manager as a
295	295	result of point-of-sale prescription medication cla ims
296	296	processing during the coverage year from a
297	297	manufacturer, dispensing pharmacy, or other party to
298	298	the transaction, or
299	299	b. reasonable estimates of any fees and other
300	300	administrative costs that are passed through to the
301	301	health insurer as a result of point -of-sale
302	302	prescription medication claims processing and serve to
303	303	reduce the health insurer ’s prescription medication
304	304	liabilities for the coverage year; and
305	305	13. “Provider contract” means any contract between a health
306	306	care provider and a health insurer, or an i nsurer’s network,
307	307	provider panel, intermediary, or representative, relating to the
308	308	provision of health care services.
309	309	B. Any health insurer or pharmacy benefits manager that issu es,
310	310	renews, or amends a health benefit plan with prescription drug
311	311	coverage shall not impose an excess cost burden on an insured.
312	312	C. When contracting with a health insurer or health benefit
313	313	plan to administer pharmacy benefits, a pharmacy benefits manager
314	314
315	315
316	316	Req. No. 679 Page 5 1
317	317	2
318	318	3
319	319	4
320	320	5
321	321	6
322	322	7
323	323	8
324	324	9
325	325	10
326	326	11
327	327	12
328	328	13
329	329	14
330	330	15
331	331	16
332	332	17
333	333	18
334	334	19
335	335	20
336	336	21
337	337	22
338	338	23
339	339	24
340	340	1
341	341	2
342	342	3
343	343	4
344	344	5
345	345	6
346	346	7
347	347	8
348	348	9
349	349	10
350	350	11
351	351	12
352	352	13
353	353	14
354	354	15
355	355	16
356	356	17
357	357	18
358	358	19
359	359	20
360	360	21
361	361	22
362	362	23
363	363	24
364	364
365	365	shall offer the health benefit plan the option of extending point -
366	366	of-sale rebates to enrollees of the plan.
367	367	D. Prescription drug cost -sharing for an insured shall be the
368	368	lesser of:
369	369	1. The applicable copayment for the prescription medication
370	370	that would be payable in the absence of this section;
371	371	2. The maximum allowable cost;
372	372	3. The maximum allowable claim;
373	373	4. The adjusted out -of-pocket amount as determined pursuant to
374	374	this section;
375	375	5. The amount an insured would pay for the prescription
376	376	medication if the insured purchased it without using his or her
377	377	health benefit plan or any other source of prescription medication
378	378	benefits or discounts; or
379	379	6. The amount the pharmacy will be reimbursed for the
380	380	prescription medication by the health insurer or pharmacy benefits
381	381	manager.
382	382	E. The Insurance Commissioner shall promulgate rules to
383	383	effectuate the provisions of this section.
384	384	SECTION 3. This act shall become effective November 1, 2025.
385	385
386	386	60-1-679 CAD 12/17/2024 10:51:28 AM

Oklahoma 2025 Regular Session

Oklahoma Senate Bill SB34 Compare Versions