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