SB 2074 — Pharmacy benefit managers; prohibiting PBM from refusing to accept documentation; requiring information to be included in appeal. Effective date.

ENGROSSEDAn Act ENROLLED SENATE BILL NO.

Alvord, Coleman, Murdock, Bullard, Jech, and BullardBurns of the Senate and StinsonStinson, Cantrell, Archer, and Manger of the House 6 An Act relating to pharmacy benefits managers;

BESUBJECT: IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:

Pharmacy benefits managers BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:

“Acquisition cost” means the total amount paid by a provider to acquire a drug, medical product, or device at the time of ENGR.purchase as evidenced by verifiable purchase documentation such as an invoice or electronic price file.

S.

B.

NO.

2074 Page 1 purchase as evidenced by verifiable purchase documentation such as an invoice or electronic price file.

ENGR.4.

S.

B.

NO.

2074 Page 2 4.

“Maximum allowable cost”, “MAC”, or “MAC list” means the list of drug products delineating the maximum per-unit reimbursement forENR. multiple-source prescription drugs, medical product products, or device devices;

S.

B.

NO.

2074 Page 2 for multiple-source prescription drugs, medical product products, or device devices;

claims processing, retail network management and payment of claims to pharmacies for prescription drugs dispensed to covered individuals, ENGR.b.

S.

B.

NO.

2074 Page 3 b.

“Provider” means a pharmacy licensed by the State Board of Pharmacy, or an agent or representative of a pharmacy, including, butENR. not limited to, the pharmacy’s contracting agent, which dispenses prescription drugs or devices to covered individuals.

B.

Nothing in the definition of pharmacy benefits management or pharmacy benefits manager in the Patient’s Right to Pharmacy Choice Act, Pharmacy Audit Integrity Act, or Sections 357 through 360 360.1 of this title shall deem an employer a “pharmacy benefits manager” of its own self-funded health benefit plan, except, to the extent ENGR.

2074 Page 43 permittedbut bynot applicablelimited law,to, where the employer,pharmacy’s withoutcontracting theagent, utilizationwhich ofdispenses aprescription thirddrugs partyor anddevices unrelated to thecovered employer’sindividuals. own pharmacy:

B.

Nothing in the definition of pharmacy benefits management or pharmacy benefits manager in the Patient’s Right to Pharmacy Choice Act, Pharmacy Audit Integrity Act, or Sections 357 through 360 360.1 of this title shall deem an employer a “pharmacy benefits manager” of its own self-funded health benefit plan, except, to the extent permitted by applicable law, where the employer, without the utilization of a third party and unrelated to the employer’s own pharmacy:

In order to place a drug on the MAC list, ensure that the drug is listed as “A” or “B” rated in the most recent version of the United States Food and Drug Administration (FDA) Approved Drug Products with Therapeutic Equivalence Evaluations, also known as the Orange Book, and the drug is generally available for purchase by ENGR.pharmacies in the state from national or regional wholesalers and is not obsolete;

ENR.

2074 Page 54 pharmacies3. in the state from national or regional wholesalers and is not obsolete;

3.

If a price update is warranted, the pharmacy benefits manager PBM shall make the change in the reimbursement amount, permit the dispensing pharmacy to ENGR.reverse and rebill the claim in question, and make the reimbursement amount change retroactive and effective for all contracted providers;

S.

B.

NO.

2074 Page 6 reverse and rebill the claim in question, and make the reimbursement amount change retroactive and effective for all contracted providers;

If the NDC number provided by the pharmacy benefits manager PBM is not available below the acquisition cost obtained from the pharmaceutical wholesaler from whom the dispensing pharmacy purchases the majority of the prescription drugs that are dispensed, theENR. pharmacy benefits manager PBM shall immediately adjust the reimbursement amount, permit the dispensing pharmacy to reverse and rebill the claim in question, and make the reimbursement amount adjustment retroactive and effective for all contracted providers;