Oklahoma § 36-3634.4 - Prescription drug or device coverage – Uniform

§ 36-3634.4. Prescription drug or device coverage – Uniform

prescription drug information on card or technology.

A. 1. It is the intent of the Legislature to:

a.

lessen waiting times of patients,

b.

decrease administrative burdens for pharmacies, and

c.

improve care to patients,

by minimizing confusion, eliminating unnecessary paperwork and

streamlining dispensing of prescription products paid for by thirdparty payors.

2. This section shall be broadly applied and interpreted to

effectuate this purpose.

B. 1. Each health benefit plan that provides coverage for

prescription drugs or devices, or administers such a plan including,

but not limited to, third-party administrators for self-insured

plans, to the extent permitted by the Employee Retirement Income

Oklahoma Statutes - Title 36. Insurance

Security Act of 1974 (ERISA), and state-administered plans, or the

plan’s agents or contractors that issue a card or other technology

for prescription claims submission and adjudication, shall issue to

its insureds covered by such plan a card or other technology

containing uniform prescription drug information. Nothing in this

section shall require any health benefit plan, or the plan’s agents

or contractors to issue a separate card of other technology for

prescription coverage, provided that the card issued can accommodate

the information required by this section.

2. The uniform prescription drug information contained on the

insured’s card or other technology shall include the following

fields:

a.

card issuer name or logo on the front of the card,

b.

complete information for electronic claims routing

including:

(1) issuer identification number (IIN/BIN) labeled as

IIN or BIN,

(2) the Processor Control Number (PCN), labeled as

PCN, if required for proper routing of electronic

claim transactions for prescription benefits, and

(3) the group number, labeled as GRP, if required for

proper routing of electronic claim transactions

for prescription benefits,

c.

card issuer identification,

d.

card holder identification, which shall be displayed

on the front of the card,

e.

card holder name, which shall be displayed on the

front of the card,

f.

claims processor name and, if not filed

electronically, address, and

g.

a help desk phone number that pharmacy providers may

call for pharmacy benefit claims assistance.

C. 1. The new uniform prescription drug information contained

on the insured’s card or other technology, as required by subsection

B of this section, shall be issued by a health benefit plan or the

plan’s administrators, agents or contractors upon enrollment, and

reissued within a reasonable time upon any change in the coverage of

the insured person that impacts data contained on the card.

2. Newly issued cards or technology shall be updated with the

latest coverage information.

D. As used in this section, "health benefit plan" means an

accident and health insurance policy or certificate, a nonprofit

hospital or medical service corporation contract, a health

maintenance organization subscriber contract, a plan provided by a

multiple employer welfare arrangement, or a plan provided by another

benefit arrangement, to the extent permitted by ERISA of 1974, as

amended, or by any waiver of or other exception to that act provided

Oklahoma Statutes - Title 36. Insurance

under federal law or regulation. The term "health benefit plan"

shall not include the following types of insurance:

1. Accident;

2. Credit;

3. Disability income;

4. Long-term or nursing home care;

5. Specified disease;

6. Dental or vision;

7. Coverage issued as a supplement to liability insurance;

8. Medical payments under automobile or homeowners;

9. Insurance under which benefits are payable with or without

regard to fault and this is statutorily required to be contained in

any liability policy or equivalent self-insurance;

10. Health benefit plans that participate or contract with the

Oklahoma Health Care Authority as the state Medicaid agency; and

11. Hospital income or indemnity.

E. The provisions of this section shall apply to health benefit

plans that are delivered, issued for delivery, or renewed on and

after January 1, 2004.

F. 1. Enforcement of the provisions of this section shall be

the responsibility of the Insurance Commissioner.

2. The Insurance Commissioner shall promulgate rules necessary

to effectuate the provisions of this section.

3. The Insurance Commissioner shall take action or impose

appropriate penalties to bring noncomplying entities into full

compliance with the provisions of this section.

Added by Laws 2002, c. 409, § 2, eff. Nov. 1, 2003.