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1 STATE OF OKLAHOMA
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2 2nd Session of the 60th Legislature (2026)
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3 SENATE BILL 1500 By: Jech
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6 AS INTRODUCED
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7 An Act relating to pharmacy benefits managers;
7 amending 59 O.S. 2021, Section 357, as last amended
8 by Section 2, Chapter 414, O.S.L. 2025 (59 O.S. Supp.
8 2025, Section 357), which relates to definitions;
9 defining terms; updating statutory references;
9 updating statutory language; prohibiting certain
10 payment from being conditioned on certain provisions;
10 prohibiting certain provider from bearing certain
11 risks; requiring certain payor to remit certain
11 payment within certain time frame; requiring certain
12 payor to provide providers with certain accounting;
12 establishing certain requirements for certain
13 accounting; prohibiting certain payor from certain
13 actions; requiring certain payments made outside of
14 certain time frame to accrue interest; authorizing
14 the Attorney General to levy certain fines;
15 establishing certain contracts as void; allowing the
15 Attorney General to promulgate rules; making certain
16 claims applicable to certain provisions; providing
16 for codification; and providing an effective date.
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19 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
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20 SECTION 1. AMENDATORY 59 O.S. 2021, Section 357, as last
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21 amended by Section 2, Chapter 414, O.S.L. 2025 (59 O.S. Supp. 2025,
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22 Section 357), is amended to read as follows:
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23 Section 357. A. As used in Sections 357 through 360 360.1 of
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24 this title:
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1 1. "Clean claim" means a claim that is submitted in accordance
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2 with all applicable billing requirements, contains all information
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3 reasonably necessary for adjudication, and is not subject to an
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4 unresolved eligibility or coverage dispute at the time of
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5 submission;
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6 2. "Claim" means a request for payment or reimbursement
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7 submitted by a provider for prescription drugs, pharmacy-dispensed
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8 medical supplies or devices, professional pharmacy services, or
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9 manufacturer coupon, copay-assistance, discount card, or other
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10 similar transactions;
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11 3. "Covered entity" means a nonprofit hospital or medical
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12 service organization, for-profit hospital or medical service
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13 organization, insurer, health benefit plan, health maintenance
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14 organization, health program administered by the state in the
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15 capacity of providing health coverage, or an employer, labor union,
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16 or other group of persons that provides health coverage to persons
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17 in this state. This term does not include a health benefit plan
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18 that provides coverage only for accidental injury, specified
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19 disease, hospital indemnity, disability income, or other limited
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20 benefit health insurance policies and contracts that do not include
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21 prescription drug coverage;
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22 2. 4. "Covered individual" means a member, participant,
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23 enrollee, contract holder or policy holder or beneficiary of a
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24 covered entity who is provided health coverage by the covered
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1 entity. A covered individual includes any dependent or other person
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2 provided health coverage through a policy, contract or plan for a
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3 covered individual;
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4 3. 5. "Department" means the Insurance Department;
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5 4. 6. "Effective rate contracting" means any agreement or
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6 arrangement between a pharmacy or contracting agent acting on behalf
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7 of a pharmacy and a pharmacy benefits manager for pharmaceuticals
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8 based on the effective rate of payment rather than a predetermined
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9 fixed price or fixed discount percentage;
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10 5. 7. "Maximum allowable cost", "MAC", or "MAC list" means the
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11 list of drug products delineating the maximum per-unit reimbursement
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12 for multiple-source prescription drugs, medical product products, or
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13 device devices;
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14 6. 8. "Multisource drug product reimbursement" (reimbursement)
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15 means the total amount paid to a pharmacy inclusive of any reduction
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16 in payment to the pharmacy, excluding prescription dispense fees and
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17 professional fees;
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18 7. 9. "Office" means the Office of the Attorney General;
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19 8. 10. "Payor" means any person or entity that adjudicates
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20 processes, administers, controls, or funds payment or reimbursement
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21 of a pharmacy claim including, but not limited to:
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22 a. pharmacy benefits managers,
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23 b. health insurers,
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24 c. health maintenance organizations,
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1 d. third-party administrators,
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2 e. self-funded or fully insured health benefit plans,
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3 f. government health programs,
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4 g. manufacturer coupon card, copay-assistance, or patient
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5 assistance programs,
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6 h. discount card, voucher, rebate, or similar program
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7 administrators, and
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8 i. any affiliate, agent, or contractor acting on behalf
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9 of an entity provided in this paragraph;
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10 11. "Pharmacy benefits management" means a service provided to
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11 covered entities to facilitate the provision of prescription drug
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12 benefits to covered individuals within the state, including
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13 negotiating pricing and other terms with drug manufacturers and
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14 providers. Pharmacy benefits management may include any or all of
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15 the following services:
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16 a. claims processing, retail network management and
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17 payment of claims to pharmacies for prescription drugs
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18 dispensed to covered individuals,
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19 b. clinical formulary development and management
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20 services, or
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21 c. rebate contracting and administration;
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22 9. 12. "Pharmacy benefits manager" or "PBM" means a person,
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23 business, or other entity that performs pharmacy benefits
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24 management. The term shall include a person or entity acting on
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1 behalf of a PBM in a contractual or employment relationship in the
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2 performance of pharmacy benefits management for a managed care
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3 company, nonprofit hospital, medical service organization, insurance
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4 company, third-party payor, or a health program administered by an
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5 agency or department of this state;
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6 10. 13. "Plan sponsor" means the employers, insurance
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7 companies, unions and health maintenance organizations or any other
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8 entity responsible for establishing, maintaining, or administering a
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9 health benefit plan on behalf of covered individuals; and
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10 11. 14. "Provider" means a pharmacy licensed by the State Board
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11 of Pharmacy, or an agent or representative of a pharmacy, including,
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12 but not limited to, the pharmacy's contracting agent, which
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13 dispenses prescription drugs or devices to covered individuals; and
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14 15. "Receipt" means the date on which a pharmacy claim is first
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15 received by a payor or any agent of the payor, regardless of
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16 internal routing or processing.
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17 B. Nothing in the definition of pharmacy benefits management or
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18 pharmacy benefits manager in the Patient's Right to Pharmacy Choice
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19 Act, Pharmacy Audit Integrity Act, or Sections 357 through 360 360.1
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20 of this title shall deem an employer a "pharmacy benefits manager"
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21 of its own self-funded health benefit plan, except, to the extent
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22 permitted by applicable law, where the employer, without the
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23 utilization of a third party and unrelated to the employer's own
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24 pharmacy:
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1 a. negotiates 1. Negotiates directly with drug
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2 manufacturers,;
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3 b. processes 2. Processes claims on behalf of its members,;
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4 or
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5 c. manages 3. Manages its own retail network of pharmacies.
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6 SECTION 2. NEW LAW A new section of law to be codified
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7 in the Oklahoma Statutes as Section 360.2 of Title 59, unless there
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8 is created a duplication in numbering, reads as follows:
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9 A. Payment to a provider for a claim shall not be conditioned
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10 upon post-transaction reconciliation, manufacturer funding cycles,
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11 or internal settlement between program sponsors, administrators, or
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12 affiliates.
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13 B. A provider shall not bear the risk of delayed or failed
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14 funding between a manufacturer, administrator, or other third party
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15 after a claim is adjudicated or accepted at the point of sale.
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16 C. A payor shall remit full payment for a clean claim no later
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17 than thirty (30) calendar days after the earlier of the receipt of
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18 the clean claim or the adjudication of the claim. Nothing in this
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19 subsection shall prohibit or discourage payment in a shorter time
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20 period, including expedited payment of electronically submitted
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21 claims.
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22 D. A payor shall provide a provider with a clear, accurate, and
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23 individualized accounting of all payments made to the provider for
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24 claims. The accounting shall be provided in a readable, itemized
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1 format, including electronic remittance advice or other electronic
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2 format commonly used in the pharmacy industry, and shall not require
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3 the provider to aggregate, infer, or reconstruct claim-level payment
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4 information. Such accounting shall be provided with each payment or
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5 remittance and shall be presented at a claim-by-claim level that
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6 reasonably allows the provider to identify:
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7 1. A unique claim identifier or prescription number;
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8 2. The date of service or dispensing date;
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9 3. The amount paid for the claim by the payor;
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10 4. The amount paid for the claim by the patient or plan number;
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11 5. Any amounts withheld, reduced, or adjusted, including the
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12 reason for such adjustment;
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13 6. Any fees, assessments, or offsets applied to the claim;
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14 7. The identity of the payor or program responsible for the
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15 payment, including identification of any manufacturer coupon, copay-
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16 assistance, or discount card program involved; and
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17 8. The final payment date for the claim.
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18 E. A payor shall not:
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19 1. Bundle or net multiple claims in a manner that obscures
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20 claim-level payment information;
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21 2. Provide only summary, aggregate, or plan-level payment data
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22 in lieu of individualized claim accounting;
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23 3. Condition access to individualized claim accounting on
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24 additional fees, portal subscriptions, or contractual waivers;
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1 4. Delay payment of an adjudicated or accepted claim beyond the
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2 time frames established pursuant to subsection C of this section;
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3 5. Retroactively reprice, reverse, or withhold payment after
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4 adjudication, except as otherwise expressly permitted by state law;
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5 6. Condition or withhold payment based on audits conducted
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6 after adjudication;
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7 7. Extend payment timelines through contract, policy, program
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8 terms, or operating rules inconsistent with subsection C of this
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9 section; or
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10 8. Shift payment risk to a provider due to internal disputes,
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11 funding delays, or administrative issues of the payor or the payor's
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12 affiliates.
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13 F. Any payment not made within the time frame set forth in
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14 subsection C of this section shall automatically accrue interest
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15 beginning on the day after the expiration of such time frame. Such
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16 interest shall accrue at a rate of ten percent (10%) per month,
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17 calculated solely on the unpaid amount owed by the payor to the
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18 provider. Interest assessed pursuant to this subsection shall be
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19 non-waivable and shall be paid in addition to the underlying claim
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20 amount.
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21 G. A payor may be subject to any fines, penalties, and remedies
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22 provided by state law. The Attorney General may levy a civil or
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23 administrative fine not less than One Hundred Dollars ($100.00) and
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1 not more than Ten Thousand Dollars ($10,000.00) per each violation
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2 of this act.
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3 H. Any contract, agreement, policy, or program term that
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4 waives, limits, or extends the rights or timelines established
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5 pursuant to this act shall be void and unenforceable.
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6 I. The Attorney General may promulgate any rules necessary to
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7 enforce the provisions of this act.
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8 J. This section shall be applicable to all claims paid on or
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9 after the effective date of this act regardless of the date a
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10 contract or program was executed or the payment methodology or
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11 reimbursement model used by the payor.
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12 SECTION 3. This act shall become effective November 1, 2026.
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Req. No. 2420 Page 9Every fact on this page links to its source, starting with the official bill record.