The bill amends various sections of the Oklahoma Statutes concerning pharmacy audits and the operations of pharmacy benefit managers (PBMs). Key changes include new audit procedures that require pharmacies to receive at least fourteen days' notice before an audit and ensure that audits do not disrupt pharmacist services. It also protects pharmacies from penalties for clerical errors unless there is evidence of fraudulent intent and allows pharmacies to use drug purchase records without limitations to validate prescriptions. Additionally, the bill caps the number of prescriptions that can be audited annually and introduces the definition of "effective rate contracting," along with responsibilities for PBMs to regularly update maximum allowable cost (MAC) pricing and maintain a transparent appeals process for reimbursement disputes.

Moreover, the legislation imposes new regulations on PBMs, prohibiting them from requiring pharmacies to log into a system for claim appeals and mandating retroactive adjustments to reimbursement amounts if a below-cost appeal is denied. PBMs must provide detailed reasons for appeal denials and cannot place drugs on a MAC list unless at least two therapeutically equivalent options are available. The bill also requires PBMs that lease their provider networks to notify contracted providers and prohibits effective rate contracting in pharmacy agreements, with penalties for violations. The provisions of this bill are set to take effect on November 1, 2025.

Statutes affected:
Introduced: 59-356.2, 59-357, 59-360
House Committee Substitute for Senate Bill: 59-356.2, 59-357, 59-360
Floor (House): 59-356.2, 59-357, 59-360
Floor (Senate): 59-356.2, 59-357, 59-360
Engrossed: 59-356.2, 59-357, 59-360
Amended And Engrossed: 59-356.2, 59-357, 59-360
Enrolled (final version): 59-356.2, 59-357, 59-360