Oklahoma SB 2007: Pharmacy Benefit Managers; requiring PBM to remit certain fees. Effective date.

Bill Text

An Act
ENROLLED SENATE
BILL NO. 2007 By: Wingard, Bullard, and Burns
of the Senate

and

Stinson, West (Tammy), and
Archer of the House

An Act relating to pharmacy benefits managers;
amending 59 O.S. 2021, Section 360, as last amended
by Section 8, Chapter 300, O.S.L. 2025 (59 O.S. Supp.
2025, Section 360), which relates to pharmacy
benefits manager contractual duties to provider;
requiring pharmacy benefits manager to remit certain
fees in certain situations; updating statutory
language; and providing an effective date.

SUBJECT: Pharmacy benefits managers

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

SECTION 1. AMENDATORY 59 O.S. 2021, Section 360, as last
amended by Section 8, Chapter 300, O.S.L. 2025 (59 O.S. Supp. 2025,
Section 360), is amended to read as follows:

Section 360. A. The pharmacy benefits manager (PBM) shall,
with respect to contracts between a pharmacy benefits manager and a
provider, including a pharmacy service administrative organization:

l. Include in such contracts the specific sources utilized to
determine the maximum allowable cost (MAC) pricing of the pharmacy,
update MAC pricing at least every seven (7) calendar days, and
establish a process for providers to readily access the MAC list
specific to that provider;

ENR. S. B. NO. 2007 Page 2
2. 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
pharmacies in the state from national or regional wholesalers and is
not obsolete;

3. Ensure dispensing fees are not included in the calculation
of MAC price reimbursement to pharmacy providers;

4. Provide a reasonable administration appeals procedure to
allow a provider, a provider’s representative and a pharmacy service
administrative organization to contest reimbursement amounts within
fourteen (14) calendar days of the final adjusted payment date. The
pharmacy benefits manager shall not prevent the pharmacy or the
pharmacy service administrative organization from filing
reimbursement appeals in an electronic batch format. The pharmacy
benefits manager must PBM shall respond to a provider, a provider’s
representative and a pharmacy service administrative organization
who have contested a reimbursement amount through this procedure
within ten (10) calendar days. The pharmacy benefits manager must
PBM shall respond in an electronic batch format to reimbursement
appeals filed in an electronic batch format. The pharmacy benefits
manager PBM shall not require a pharmacy or pharmacy services
administrative organization to log into a system to upload
individual claim appeals or to download individual appeal responses.
If a price update is warranted, the pharmacy benefits manager PBM
shall make the change in the reimbursement amount, permit the
dispensing pharmacy to reverse and rebill the claim in question, and
make the reimbursement amount change retroactive and effective for
all contracted providers;

5. If a below-cost reimbursement appeal is denied, the PBM
shall provide the reason for the denial, including the National Drug
Code (NDC) number from, and the name of, the specific national or
regional wholesalers doing business in this state where the drug is
currently in stock and available for purchase by the dispensing
pharmacy at a price below the PBM’s reimbursement price. The PBM
shall include documented proof from the specific national or
regional wholesalers doing business in this state showing that the
drug is currently in stock and available for purchase by the

ENR. S. B. NO. 2007 Page 3
dispensing pharmacy at a price below the PBM’s reimbursement price.
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,
the 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;

6. If a PBM increases reimbursement for a drug, medical
product, or device as a result of an appeal pursuant to this
subsection, including an adjustment required pursuant to paragraph 5
of this subsection, and reduces the reimbursement amount for the
same drug, medical product, or device, including the same NDC
number, within thirty (30) calendar days of the appeal
determination, the PBM shall remit an administrative fee not less
than One Hundred Dollars ($100.00) to the affected provider for each
occurrence. If such fees are not remitted after ninety (90)
calendar days, the administrative fee shall not be less than Five
Hundred Dollars ($500.