The bill amends the Oklahoma Statutes to enhance regulations surrounding pharmacy benefit managers (PBMs) and their auditing practices. Key provisions include new language that permits pharmacies to utilize drug purchase records without restrictions on date or source for validating prescription drug dispensing. It also establishes uniform audit standards for all pharmacies, requiring written notice before audits, prohibiting recoupment for clerical errors unless fraud is demonstrated, and limiting audits to one year from the claim submission date. Additionally, the bill introduces the concept of "effective rate contracting" and mandates that PBMs update maximum allowable cost (MAC) pricing at least every seven days, ensuring that dispensing fees are excluded from MAC calculations.

Further, the legislation outlines specific requirements for PBMs regarding reimbursement practices, including the obligation to provide detailed reasons for denying below-cost reimbursement appeals and to adjust reimbursement amounts retroactively if necessary. It prohibits PBMs from placing drugs on a MAC list without at least two therapeutically equivalent options available and ensures that reimbursement for drugs listed in the FDA Drug Shortages Database is no less than the wholesale acquisition cost. The bill also restricts PBMs from leasing their provider networks, establishes minimum reimbursement rates based on the National Average Drug Acquisition Cost (NADAC) and wholesale acquisition cost (WAC), and mandates annual increases in professional fees for pharmacies based on inflation. The act is scheduled to take effect on November 1, 2025.

Statutes affected:
Introduced: 59-356.2, 59-357, 59-360