Shown verbatim: the complete text as captured from the official PDF posted by the Oklahoma Legislature, fetched 2026-07-23. Page and line markers are part of the official record; nothing is edited or removed. The official bill page.
1 STATE OF OKLAHOMA
1
2 1st Session of the 60th Legislature (2025)
2
3 SENATE BILL 161 By: Hicks
3
4
4
5
5
6 AS INTRODUCED
6
7 An Act relating to pharmacy benefits management;
7 amending 36 O.S. 2021, Section 6962, as last amended
8 by Section 2, Chapter 306, O.S.L. 2024 (36 O.S. Supp.
8 2024, Section 6962), which relates to pharmacy
9 benefits manager compliance; requiring pharmacy
9 benefits manager to maintain certain fiduciary duty;
10 updating statutory language; and providing an
10 effective date.
11
11
12
12
13 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
13
14 SECTION 1. AMENDATORY 36 O.S. 2021, Section 6962, as
14
15 last amended by Section 2, Chapter 306, O.S.L. 2024 (36 O.S. Supp.
15
16 2024, Section 6962), is amended to read as follows:
16
17 Section 6962. A. The Attorney General shall review and approve
17
18 retail pharmacy network access for all pharmacy benefits managers
18
19 (PBMs) to ensure compliance with Section 6961 of this title.
19
20 B. A PBM, or an agent of a PBM, shall not:
20
21 1. Cause or knowingly permit the use of advertisement,
21
22 promotion, solicitation, representation, proposal or offer that is
22
23 untrue, deceptive or misleading;
23
24
24
Req. No. 674 Page 1
1 2. Charge a pharmacist or pharmacy a fee related to the
1
2 adjudication of a claim including without limitation a fee for:
2
3 a. the submission of a claim,
3
4 b. enrollment or participation in a retail pharmacy
4
5 network, or
5
6 c. the development or management of claims processing
6
7 services or claims payment services related to
7
8 participation in a retail pharmacy network;
8
9 3. Reimburse a pharmacy or pharmacist in the state an amount
9
10 less than the amount that the PBM reimburses a pharmacy owned by or
10
11 under common ownership with a PBM for providing the same covered
11
12 services. The reimbursement amount paid to the pharmacy shall be
12
13 equal to the reimbursement amount calculated on a per-unit basis
13
14 using the same generic product identifier or generic code number
14
15 paid to the PBM-owned or PBM-affiliated pharmacy;
15
16 4. Deny a provider the opportunity to participate in any
16
17 pharmacy network at preferred participation status if the provider
17
18 is willing to accept the terms and conditions that the PBM has
18
19 established for other providers as a condition of preferred network
19
20 participation status;
20
21 5. Deny, limit or terminate a provider's contract based on
21
22 employment status of any employee who has an active license to
22
23 dispense, despite probation status, with the State Board of
23
24 Pharmacy;
24
Req. No. 674 Page 2
1 6. Retroactively deny or reduce reimbursement for a covered
1
2 service claim after returning a paid claim response as part of the
2
3 adjudication of the claim, unless:
3
4 a. the original claim was submitted fraudulently, or
4
5 b. to correct errors identified in an audit, so long as
5
6 the audit was conducted in compliance with Sections
6
7 356.2 and 356.3 of Title 59 of the Oklahoma Statutes;
7
8 7. Fail to make any payment due to a pharmacy or pharmacist for
8
9 covered services properly rendered in the event a PBM terminates a
9
10 provider from a pharmacy benefits manager network;
10
11 8. Conduct or practice spread pricing, as defined in Section
11
12 6960 of this title, in this state; or
12
13 9. Charge a pharmacist or pharmacy a fee related to
13
14 participation in a retail pharmacy network including, but not
14
15 limited to, the following:
15
16 a. an application fee,
16
17 b. an enrollment or participation fee,
17
18 c. a credentialing or re-credentialing fee,
18
19 d. a change of ownership fee, or
19
20 e. a fee for the development or management of claims
20
21 processing services or claims payment services.
21
22 C. The prohibitions under this section shall apply to contracts
22
23 between pharmacy benefits managers and providers for participation
23
24 in retail pharmacy networks.
24
Req. No. 674 Page 3
1 1. A PBM contract shall:
1
2 a. not restrict, directly or indirectly, any pharmacy
2
3 that dispenses a prescription drug from informing, or
3
4 penalize such pharmacy for informing, an individual of
4
5 any differential between the individual's out-of-
5
6 pocket cost or coverage with respect to acquisition of
6
7 the drug and the amount an individual would pay to
7
8 purchase the drug directly, and
8
9 b. ensure that any entity that provides pharmacy benefits
9
10 management services under a contract with any such
10
11 health plan or health insurance coverage does not,
11
12 with respect to such plan or coverage, restrict,
12
13 directly or indirectly, a pharmacy that dispenses a
13
14 prescription drug from informing, or penalize such
14
15 pharmacy for informing, a covered individual of any
15
16 differential between the individual's out-of-pocket
16
17 cost under the plan or coverage with respect to
17
18 acquisition of the drug and the amount an individual
18
19 would pay for acquisition of the drug without using
19
20 any health plan or health insurance coverage.
20
21 2. A pharmacy benefits manager's contract with a provider shall
21
22 not prohibit, restrict, or limit disclosure of information or
22
23 documents to the Attorney General, law enforcement or state and
23
24 federal governmental officials investigating or examining a
24
Req. No. 674 Page 4
1 complaint or conducting a review of a pharmacy benefits manager's
1
2 compliance with the requirements under the Patient's Right to
2
3 Pharmacy Choice Act, the Pharmacy Audit Integrity Act, and Sections
3
4 357 through 360 of Title 59 of the Oklahoma Statutes.
4
5 D. A pharmacy benefits manager shall:
5
6 1. Establish and maintain an electronic claim inquiry
6
7 processing system using the National Council for Prescription Drug
7
8 Programs' Programs's current standards to communicate information to
8
9 pharmacies submitting claim inquiries;
9
10 2. Fully disclose to insurers, self-funded employers, unions or
10
11 other PBM clients the existence of the respective aggregate
11
12 prescription drug discounts, rebates received from drug
12
13 manufacturers and pharmacy audit recoupments;
13
14 3. Provide the Attorney General, insurers, self-funded employer
14
15 plans and unions unrestricted audit rights of and access to the
15
16 respective PBM pharmaceutical manufacturer and provider contracts,
16
17 plan utilization data, plan pricing data, pharmacy utilization data
17
18 and pharmacy pricing data;
18
19 4. Maintain, for no less than three (3) years, documentation of
19
20 all network development activities including, but not limited to,
20
21 contract negotiations and any denials to providers to join networks.
21
22 This documentation shall be made available to the Attorney General
22
23 upon request; and
23
24
24
Req. No. 674 Page 5
1 5. Report to the Attorney General, on a quarterly basis for
1
2 each health insurer payor, on the following information:
2
3 a. the aggregate amount of rebates received by the PBM,
3
4 b. the aggregate amount of rebates distributed to the
4
5 appropriate health insurer payor,
5
6 c. the aggregate amount of rebates passed on to the
6
7 enrollees of each health insurer payor at the point of
7
8 sale that reduced the applicable deductible,
8
9 copayment, coinsure or other cost sharing amount of
9
10 the enrollee,
10
11 d. the individual and aggregate amount paid by the health
11
12 insurer payor to the PBM for pharmacy services
12
13 itemized by pharmacy, drug product and service
13
14 provided, and
14
15 e. the individual and aggregate amount a PBM paid a
15
16 provider for pharmacy services itemized by pharmacy,
16
17 drug product and service provided; and
17
18 6. Maintain a fiduciary duty to insurers and insureds served by
18
19 the PBM.
19
20 E. Nothing in the Patient's Right to Pharmacy Choice Act shall
20
21 prohibit the Attorney General from requesting and obtaining detailed
21
22 data, including raw data, in response to the information provided by
22
23 a PBM in the quarterly reports required by this section. The
23
24
24
Req. No. 674 Page 6
1 Attorney General may alter the frequency of the reports required by
1
2 this section at his or her sole discretion.
2
3 F. The Attorney General may promulgate rules to implement the
3
4 provisions of the Patient's Right to Pharmacy Choice Act, the
4
5 Pharmacy Audit Integrity Act, and Sections 357 through 360 of Title
5
6 59 of the Oklahoma Statutes.
6
7 SECTION 2. This act shall become effective November 1, 2025.
7
8
8
9 60-1-674 CAD 12/30/2024 11:52:39 AM
9
10
10
11
11
12
12
13
13
14
14
15
15
16
16
17
17
18
18
19
19
20
20
21
21
22
22
23
23
24
24
Req. No. 674 Page 7Every fact on this page links to its source, starting with the official bill record.