1 STATE OF OKLAHOMA
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2 1st Session of the 60th Legislature (2025)
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3 SENATE BILL 34 By: Hicks
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6 AS INTRODUCED
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7 An Act relating to prescription drugs; creating the
7 Access to Lifesaving Medicines Act; providing short
8 title; defining terms; prohibiting certain insurers
8 and pharmacy benefits managers from imposing certain
9 costs; requiring certain rebates be offered to
9 certain health benefit plans; establishing terms of
10 prescription drug cost sharing; directing
10 promulgation of rules; providing for noncodification;
11 providing for codification; and providing an
11 effective date.
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14 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
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15 SECTION 1. NEW LAW A new section of law not to be
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16 codified in the Oklahoma Statutes reads as follows:
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17 This act shall be known and may be cited as the “Access to
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18 Lifesaving Medicines Act”.
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19 SECTION 2. NEW LAW A new section of law to be codified
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20 in the Oklahoma Statutes as Section 6970 of Title 36, unless there
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21 is created a duplication in numbering, reads as follows:
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22 As used in this section:
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23 1. “Adjusted out-of-pocket amount” means the copayment,
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24 coinsurance, or other cost-sharing obligation that a health benefit
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 1 plan requires an insured to pay at the point of sale for a covered
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2 prescription medication otherwise payable, less the pro rata portion
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3 of any discounts, rebates, and price concessions in connection with
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4 the prescription drug;
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5 2. “Claim” means any bill, claim, or proof of loss made by or
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6 on behalf of an insured or a provider to a health insurer or its
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7 intermediary, administrator, or representative, with which the
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8 provider has a provider contract for payment for health care
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9 services under any health benefit plan;
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10 3. “Excess cost burden” means any copayments, coinsurance, or
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11 other cost-sharing an insured is required to pay at the point of
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12 sale to receive a prescription drug or device that exceeds the
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13 health insurer’s or pharmacy benefits manager’s net cost after
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14 applying a pro rata portion of any discounts, rebates, or
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15 concessions received from manufacturers, pharmacies, or other third
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16 parties;
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17 4. “Health benefit plan” means a health benefit plan as defined
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18 pursuant to Section 6060.4 of Title 36 of the Oklahoma Statutes;
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19 5. “Health care provider” or “provider” means a health care
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20 provider as defined pursuant to Section 3090.2 of Title 63 of the
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21 Oklahoma Statutes;
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22 6. “Health insurer” means any entity subject to the
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23 jurisdiction of the Insurance Department and the insurance laws and
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24 regulations of this state that contracts or offers to contract to
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 1 provide, deliver, arrange for, pay for, or reimburse any of the
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2 costs of health care services including, but not limited to, a
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3 health maintenance organization, a health benefit plan, or any other
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4 entity providing a plan of health insurance, health benefits, or
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5 health care services;
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6 7. “Maximum allowable claim” means the amount the health
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7 insurer or pharmacy benefits manager has agreed to pay a pharmacy;
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8 8. “Maximum allowable cost” means the maximum dollar amount
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9 that a health insurer or its intermediary will reimburse a pharmacy
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10 provider for a group of drugs rated as “A”, “AB”, “NR”, or “NA” in
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11 the most recent edition of the Approved Drug Products with
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12 Therapeutic Equivalence Evaluations, published by the United States
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13 Food and Drug Administration, or similarly rated by a nationally
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14 recognized reference;
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15 9. “Pharmacy” means a pharmacy as defined pursuant to Section
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16 353.1 of Title 59 of the Oklahoma Statutes;
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17 10. “Pharmacy benefits manager” means a pharmacy benefits
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18 manager as defined pursuant to Section 6960 of Title 36 of the
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19 Oklahoma Statutes;
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20 11. “Point of sale” means the transaction in which goods or
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21 services including, but not limited to, prescription medications,
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22 medical devices, and medical supplies are sold to the consumer;
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23 12. “Rebate” means:
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 1 a. negotiated price concessions including, but not
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2 limited to, base rebates and reasonable estimates of
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3 any price protection rebates and performance-based
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4 rebates that may accrue, directly or indirectly, to
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5 the health insurer or pharmacy benefits manager as a
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6 result of point-of-sale prescription medication claims
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7 processing during the coverage year from a
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8 manufacturer, dispensing pharmacy, or other party to
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9 the transaction, or
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10 b. reasonable estimates of any fees and other
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11 administrative costs that are passed through to the
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12 health insurer as a result of point-of-sale
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13 prescription medication claims processing and serve to
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14 reduce the health insurer’s prescription medication
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15 liabilities for the coverage year; and
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16 13. “Provider contract” means any contract between a health
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17 care provider and a health insurer, or an insurer’s network,
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18 provider panel, intermediary, or representative, relating to the
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19 provision of health care services.
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20 B. Any health insurer or pharmacy benefits manager that issues,
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21 renews, or amends a health benefit plan with prescription drug
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22 coverage shall not impose an excess cost burden on an insured.
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23 C. When contracting with a health insurer or health benefit
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24 plan to administer pharmacy benefits, a pharmacy benefits manager
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 1 shall offer the health benefit plan the option of extending point-
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2 of-sale rebates to enrollees of the plan.
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3 D. Prescription drug cost-sharing for an insured shall be the
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4 lesser of:
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5 1. The applicable copayment for the prescription medication
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6 that would be payable in the absence of this section;
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7 2. The maximum allowable cost;
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8 3. The maximum allowable claim;
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9 4. The adjusted out-of-pocket amount as determined pursuant to
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10 this section;
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11 5. The amount an insured would pay for the prescription
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12 medication if the insured purchased it without using his or her
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13 health benefit plan or any other source of prescription medication
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14 benefits or discounts; or
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15 6. The amount the pharmacy will be reimbursed for the
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16 prescription medication by the health insurer or pharmacy benefits
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17 manager.
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18 E. The Insurance Commissioner shall promulgate rules to
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19 effectuate the provisions of this section.
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20 SECTION 3. This act shall become effective November 1, 2025.
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22 60-1-679 CAD 12/17/2024 10:51:28 AM
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