SB 161 — Pharmacy benefit management; requiring pharmacy benefit managers to maintain certain fiduciary duty. Effective date.

STATESENATE OFFLOOR OKLAHOMAVERSION 2February 1st20, Session2025 ofAS theAMENDED 60th Legislature (2025) 3 SENATE BILL 161NO. By:

Hicks161 4By: 5 AS INTRODUCED 7 An Act relating to pharmacy benefits management;

amendingHicks 365 O.S.[ pharmacy benefits management - compliance - fiduciary duty - effective date ] 8 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:

2021, Section 6962, as last amended by Section 2, Chapter 306, O.S.L.

2024 (36 O.S.

Supp.

2024, Section 6962), which relates to pharmacy benefits manager compliance;

requiring pharmacy benefits manager to maintain certain fiduciary duty;

updating statutory language;

and providing an effective date.

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

Req.2.

No.Charge a pharmacist or pharmacy a fee related to the adjudication of a claim including without limitation a fee for:

674a. Page 1 2.

Charge a pharmacist or pharmacy a fee related to the 2 adjudication of a claim including without limitation a fee for:

3 a.

enrollment or participation in a retail pharmacy 5 network, or 6SENATE FLOOR VERSION - SB161 SFLR Page 1 (Bold face denotes Committee Amendments) c.

the development or management of claims processing 7 services or claims payment services related to participation in a retail pharmacy network;

9 3.

Req.6.

No.Retroactively deny or reduce reimbursement for a covered service claim after returning a paid claim response as part of the adjudication of the claim, unless:

674 Page 2 6.

Retroactively deny or reduce reimbursement for a covered 2 service claim after returning a paid claim response as part of the 3 adjudication of the claim, unless:

the original claim was submitted fraudulently, or 5SENATE FLOOR VERSION - SB161 SFLR Page 2 (Bold face denotes Committee Amendments) b.

to correct errors identified in an audit, so long as 6 the audit was conducted in compliance with Sections 7 356.2 and 356.3 of Title 59 of the Oklahoma Statutes;

Fail to make any payment due to a pharmacy or pharmacist for 9 covered services properly rendered in the event a PBM terminates a provider from a pharmacy benefits manager network;

Req.1.

No.

674 Page 3 1.

2 a.

not restrict, directly or indirectly, any pharmacy 3 that dispenses a prescription drug from informing, or penalize such pharmacy for informing, an individual of 5SENATE FLOOR VERSION - SB161 SFLR Page 3 (Bold face denotes Committee Amendments) any differential between the individual’s out-of- 6 pocket cost or coverage with respect to acquisition of 7 the drug and the amount an individual would pay to purchase the drug directly, and 9 b.

A pharmacy benefits manager’s contract with a provider shall not prohibit, restrict, or limit disclosure of information or documents to the Attorney General, law enforcement or state and federal governmental officials investigating or examining a Req.complaint or conducting a review of a pharmacy benefits manager’s compliance with the requirements under the Patient’s Right to Pharmacy Choice Act, the Pharmacy Audit Integrity Act, and Sections 357 through 360 of Title 59 of the Oklahoma Statutes.

No.SENATE FLOOR VERSION - SB161 SFLR Page 4 (Bold face denotes Committee Amendments) D.

674 Page 4 complaint or conducting a review of a pharmacy benefits manager’s 2 compliance with the requirements under the Patient’s Right to 3 Pharmacy Choice Act, the Pharmacy Audit Integrity Act, and Sections 357 through 360 of Title 59 of the Oklahoma Statutes.

5 D.

6 1.

Establish and maintain an electronic claim inquiry 7 processing system using the National Council for Prescription Drug Programs’ Programs’s current standards to communicate information to 9 pharmacies submitting claim inquiries;

and Req.5.

No.Report to the Attorney General, on a quarterly basis for each health insurer payor, on the following information:

674a. Page 5 5.