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
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2 2nd Session of the 60th Legislature (2026)
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3 SENATE BILL 2007 By: Wingard
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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 360, as last amended
8 by Section 8, Chapter 300, O.S.L. 2025 (59 O.S. Supp.
8 2025, Section 360), which relates to pharmacy
9 benefits manager contractual duties to provider;
9 requiring pharmacy benefits manager to remit certain
10 fees in certain situations; updating statutory
10 language; and providing an effective date.
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13 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
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14 SECTION 1. AMENDATORY 59 O.S. 2021, Section 360, as last
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15 amended by Section 8, Chapter 300, O.S.L. 2025 (59 O.S. Supp. 2025,
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16 Section 360), is amended to read as follows:
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17 Section 360. A. The pharmacy benefits manager (PBM) shall,
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18 with respect to contracts between a pharmacy benefits manager and a
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19 provider, including a pharmacy service administrative organization:
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20 l. Include in such contracts the specific sources utilized to
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21 determine the maximum allowable cost (MAC) pricing of the pharmacy,
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22 update MAC pricing at least every seven (7) calendar days, and
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23 establish a process for providers to readily access the MAC list
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24 specific to that provider;
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Req. No. 3073 Page 1
1 2. In order to place a drug on the MAC list, ensure that the
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2 drug is listed as "A" or "B" rated in the most recent version of the
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3 United States Food and Drug Administration (FDA) Approved Drug
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4 Products with Therapeutic Equivalence Evaluations, also known as the
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5 Orange Book, and the drug is generally available for purchase by
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6 pharmacies in the state from national or regional wholesalers and is
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7 not obsolete;
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8 3. Ensure dispensing fees are not included in the calculation
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9 of MAC price reimbursement to pharmacy providers;
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10 4. Provide a reasonable administration appeals procedure to
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11 allow a provider, a provider's representative and a pharmacy service
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12 administrative organization to contest reimbursement amounts within
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13 fourteen (14) calendar days of the final adjusted payment date. The
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14 pharmacy benefits manager shall not prevent the pharmacy or the
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15 pharmacy service administrative organization from filing
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16 reimbursement appeals in an electronic batch format. The pharmacy
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17 benefits manager must PBM shall respond to a provider, a provider's
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18 representative and a pharmacy service administrative organization
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19 who have contested a reimbursement amount through this procedure
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20 within ten (10) calendar days. The pharmacy benefits manager must
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21 PBM shall respond in an electronic batch format to reimbursement
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22 appeals filed in an electronic batch format. The pharmacy benefits
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23 manager PBM shall not require a pharmacy or pharmacy services
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24 administrative organization to log into a system to upload
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Req. No. 3073 Page 2
1 individual claim appeals or to download individual appeal responses.
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2 If a price update is warranted, the pharmacy benefits manager PBM
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3 shall make the change in the reimbursement amount, permit the
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4 dispensing pharmacy to reverse and rebill the claim in question, and
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5 make the reimbursement amount change retroactive and effective for
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6 all contracted providers;
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7 5. If a below-cost reimbursement appeal is denied, the PBM
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8 shall provide the reason for the denial, including the National Drug
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9 Code (NDC) number from, and the name of, the specific national or
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10 regional wholesalers doing business in this state where the drug is
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11 currently in stock and available for purchase by the dispensing
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12 pharmacy at a price below the PBM's reimbursement price. The PBM
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13 shall include documented proof from the specific national or
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14 regional wholesalers doing business in this state showing that the
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15 drug is currently in stock and available for purchase by the
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16 dispensing pharmacy at a price below the PBM's reimbursement price.
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17 If the NDC number provided by the pharmacy benefits manager PBM is
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18 not available below the acquisition cost obtained from the
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19 pharmaceutical wholesaler from whom the dispensing pharmacy
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20 purchases the majority of the prescription drugs that are dispensed,
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21 the pharmacy benefits manager PBM shall immediately adjust the
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22 reimbursement amount, permit the dispensing pharmacy to reverse and
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23 rebill the claim in question, and make the reimbursement amount
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24 adjustment retroactive and effective for all contracted providers;
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Req. No. 3073 Page 3
1 6. If a PBM increases reimbursement for a drug, medical
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2 product, or device as a result of an appeal pursuant to this
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3 subsection, including an adjustment required pursuant to paragraph 5
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4 of this subsection, and reduces the reimbursement amount for the
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5 same drug, medical product, or device, including the same NDC
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6 number, within thirty (30) calendar days of the appeal
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7 determination, the PBM shall remit an administrative fee not less
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8 than One Hundred Dollars ($100.00) to the affected provider for each
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9 occurrence. If such fees are not remitted after ninety (90)
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10 calendar days, the administrative fee shall not be less than Five
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11 Hundred Dollars ($500.00) for each occurrence. If such fees are not
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12 remitted after one hundred eighty (180) calendar days, the
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13 administrative fee shall not be less than One Thousand Dollars
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14 ($1,000.00);
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15 7. Any appeal that results in an increase in the reimbursement
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16 from the PBM that continues to be below the pharmacy's acquisition
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17 cost shall be considered a denial under this section. Any denial of
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18 an appeal shall follow the requirements of paragraph paragraphs 5
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19 and 6 of this subsection; and
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20 7. 8. The PBM shall not require a pharmacy to collect
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21 additional monies following a successful below-cost reimbursement
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22 appeal from any person or entity other than the PBM who adjudicated
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23 the drug claim, including the patient or plan sponsor.
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1 B. The reimbursement appeal requirements in this section shall
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2 apply to all drugs, medical products, or devices reimbursed
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3 according to any payment methodology, including, but not limited to:
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4 1. Average acquisition cost, including the National Average
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5 Drug Acquisition Cost;
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6 2. Average manufacturer price;
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7 3. Average wholesale price;
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8 4. Brand effective rate or generic effective rate;
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9 5. Discount indexing;
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10 6. Federal upper limits;
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11 7. Wholesale acquisition cost; and
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12 8. Any other term that a pharmacy benefits manager PBM or an
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13 insurer of a health benefit plan may use to establish reimbursement
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14 rates to a pharmacist or pharmacy for pharmacist services.
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15 C. The pharmacy benefits manager PBM shall not place a drug on
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16 a MAC list, unless there are at least two therapeutically
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17 equivalent, multiple-source drugs, generally available for purchase
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18 by dispensing retail pharmacies from national or regional
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19 wholesalers.
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20 D. In the event that a drug is placed on the FDA Drug Shortages
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21 Database, pharmacy benefits managers PBMs shall reimburse claims to
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22 pharmacies at no less than the wholesale acquisition cost for the
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23 specific NDC number being dispensed.
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Req. No. 3073 Page 5
1 E. The pharmacy benefits manager PBM shall not require
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2 accreditation or licensing of providers, or any entity licensed or
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3 regulated by the State Board of Pharmacy, other than by the State
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4 Board of Pharmacy or federal government entity as a condition for
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5 participation as a network provider.
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6 F. A pharmacy or pharmacist may decline to provide the
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7 pharmacist clinical or dispensing services to a patient or pharmacy
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8 benefits manager if the pharmacy or pharmacist is to be paid less
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9 than the pharmacy's cost for providing the pharmacist clinical or
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10 dispensing services.
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11 G. The pharmacy benefits manager PBM shall provide a dedicated
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12 telephone number, email address and names of the personnel with
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13 decision-making authority regarding MAC appeals and pricing.
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14 SECTION 2. This act shall become effective November 1, 2026.
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16 60-2-3073 CAD 1/15/2026 9:49:42 AM
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Req. No. 3073 Page 6Every fact on this page links to its source, starting with the official bill record.