The bill amends Oklahoma statutes concerning pharmacy audits and pharmacy benefit managers (PBMs), introducing several key changes aimed at enhancing the fairness and transparency of pharmacy operations. It establishes new audit procedures that require pharmacies to receive at least 14 days' notice before an audit and ensures that audits do not disrupt pharmacy operations. Additionally, pharmacies are protected from penalties for clerical errors unless there is evidence of fraudulent intent. The legislation also allows pharmacies to use drug purchase records without limitations for validating prescription dispensing and caps the number of prescriptions that can be audited annually.

Moreover, the bill outlines specific responsibilities for PBMs, including the prohibition of requiring pharmacies to log into a system for claim appeals and the obligation to provide detailed reasons for appeal denials. It mandates that PBMs adjust reimbursement amounts retroactively if a below-cost reimbursement appeal is denied and prohibits placing drugs on a Maximum Allowable Cost (MAC) list unless at least two equivalent drugs are available. The bill also addresses the leasing of provider networks by PBMs, requiring notification to contracted providers and contact information for claims processing. Effective rate contracting is prohibited in agreements between pharmacies and PBMs, with violations potentially leading to penalties. The legislation 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
Amended And Engrossed: 59-356.2, 59-357, 59-360
Enrolled (final version): 59-356.2, 59-357, 59-360