Bill No. 789 seeks to amend the regulations surrounding pharmacy audits and the operations of pharmacy benefit managers (PBMs) in Oklahoma. Key provisions include a requirement for audit entities to provide pharmacies with at least 14 days' written notice before an audit, and a stipulation that clerical errors cannot be classified as fraud without evidence of intent. The bill allows pharmacies to utilize drug purchase records without limitations for validating prescription dispensing and mandates that audits must occur within one year of claim submission. Additionally, pharmacies are permitted to electronically resubmit claims within 30 days of receiving a final audit report. The bill also removes previous exemptions for audits related to fraud or willful misrepresentation, ensuring all audits comply with the new standards.

Further, the bill imposes new requirements on PBMs, including the necessity to specify sources for determining maximum allowable cost (MAC) pricing in contracts, regular updates to MAC pricing, and the exclusion of dispensing fees from MAC calculations. It establishes a minimum reimbursement rate for pharmacies at 106% of the National Average Drug Acquisition Cost (NADAC) plus a professional fee of $15, which will increase annually based on inflation. The bill prohibits effective rate contracting between pharmacies and PBMs, ensuring that payment cannot be based on an effective reimbursement rate, with penalties for non-compliance. These provisions are designed to enhance transparency and fairness in pharmacy operations, ultimately benefiting both pharmacies and their patients, and the act is 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