This bill amends existing Oklahoma law regarding pharmacy benefits managers (PBMs) and their contractual obligations to providers. Key changes include the definition of "acquisition cost," which now encompasses the total amount paid by a provider for drugs, medical products, or devices, excluding any post-purchase rebates or discounts. The bill also updates the definitions of various terms related to pharmacy benefits management, such as "covered entity," "provider," and "maximum allowable cost." Additionally, it prohibits PBMs from refusing to accept documentation from providers after an appeal submission and mandates that any adjustments to reimbursement amounts include detailed claim-level information.

Furthermore, the bill establishes specific requirements for PBMs regarding the management of maximum allowable cost (MAC) pricing, including the obligation to update MAC pricing every seven days and to provide a transparent appeals process for providers contesting reimbursement amounts. It ensures that providers are not reimbursed below the national average drug acquisition cost and sets forth conditions under which drugs can be placed on the MAC list. The bill aims to enhance transparency and fairness in the reimbursement process for pharmacies, ultimately improving access to affordable medications for patients. The act is set to take effect on November 1, 2026.

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