The bill amends Section 360 of Title 59 of the Oklahoma Statutes, focusing on the responsibilities of pharmacy benefits managers (PBMs) in their contractual agreements with providers, including pharmacies. Key provisions require PBMs to disclose the sources used for determining maximum allowable cost (MAC) pricing, update MAC pricing every seven days, and ensure that dispensing fees are not factored into MAC reimbursements. Additionally, the bill mandates that PBMs provide a clear appeals process for providers contesting reimbursement amounts, respond to appeals in a timely manner, and adjust reimbursement amounts retroactively if warranted.

New provisions also introduce administrative fees for PBMs that fail to remit payments after reimbursement adjustments, with escalating fees based on the duration of the delay. The bill stipulates that PBMs cannot place drugs on the MAC list unless there are at least two therapeutically equivalent drugs available and requires that claims for drugs listed in the FDA Drug Shortages Database be reimbursed at no less than the wholesale acquisition cost. Furthermore, PBMs are prohibited from requiring unnecessary accreditation for providers and must provide accessible contact information for decision-makers regarding MAC appeals. The act is set to take effect on November 1, 2026.

Statutes affected:
Introduced: 59-360