Oklahoma § 36-6960 - Definitions

§ 36-6960. Definitions

A. For purposes of the Patient’s Right to Pharmacy Choice Act:

1. “340B drug pricing” means the pricing agreement established

under Section 602 of the Veterans Health Care Act of 1992, Pub. L.

No. 102-585;

2. “340B entity” means a covered entity as that term is defined

in 42 U.S.C., Section 256b;

3. “Covered entity” means a nonprofit hospital or medical

service organization, for-profit hospital or medical service

organization, insurer, health benefit plan, health maintenance

organization, health program administered by the state in the

capacity of providing health coverage, or an employer, labor union,

or other group of persons that provides health coverage to persons

in this state. This term does not include a health plan that

provides coverage only for accidental injury, specified disease,

hospital indemnity, disability income, or other limited benefit

Oklahoma Statutes - Title 36. Insurance

health insurance policies and contracts that do not include

prescription drug coverage;

4. “Health insurer” means any corporation, association, benefit

society, exchange, partnership or individual licensed by the

Oklahoma Insurance Code;

5. “Health insurer payor” means a health insurance company,

health maintenance organization, union, hospital and medical

services organization or any entity providing or administering a

self-funded health benefit plan;

6. “Mail-order pharmacy” means a pharmacy licensed by this

state that primarily dispenses and delivers covered drugs via common

carrier;

7. “Pharmacy benefits manager” or “PBM” means a person,

business, or other entity that performs pharmacy benefits

management. The term shall include a person or entity acting on

behalf of a PBM in a contractual or employment relationship in the

performance of pharmacy benefits management for a managed care

company, nonprofit hospital, medical service organization, insurance

company, third-party payor or a health program administered by a

department of this state;

8. “Pharmacy benefits management” means a service provided to

covered entities to facilitate the provisions of prescription drug

benefits to covered individuals within the state, including, but not

limited to, negotiating pricing and other terms with drug

manufacturers and providers. Pharmacy benefits management may

include any or all of the following services:

a.

claims processing, retail network management, and

payment of claims to pharmacies for prescription drugs

dispensed to covered individuals,

b.

administration or management of pharmacy discount

cards or programs,

c.

clinical formulary development and management

services, or

d.

rebate contracting and administration;

9. “Provider” means a pharmacy, as defined in Section 353.1 of

Title 59 of the Oklahoma Statutes or an agent or representative of a

pharmacy;

10. “Retail pharmacy network” means retail pharmacy providers

contracted with a PBM in which the pharmacy primarily fills and

sells prescriptions via a retail, storefront location;

11. “Rural service area” means a five-digit ZIP code in which

the population density is less than one thousand (1,000) individuals

per square mile;

12. “Spread pricing” means a prescription drug pricing model

utilized by a pharmacy benefits manager in which the PBM charges a

health benefit plan a contracted price for prescription drugs that

Oklahoma Statutes - Title 36. Insurance

differs from the amount the PBM directly or indirectly pays the

pharmacy or pharmacist for providing pharmacy services;

13. “Suburban service area” means a five-digit ZIP code in

which the population density is between one thousand (1,000) and

three thousand (3,000) individuals per square mile; and

14. “Urban service area” means a five-digit ZIP code in which

the population density is greater than three thousand (3,000)

individuals per square mile.

B. Nothing in the definitions of pharmacy benefits manager or

pharmacy benefits management as such terms are defined in the

Patient’s Right to Pharmacy Choice Act, the Pharmacy Audit Integrity

Act, or Sections 357 through 360 of Title 59 of the Oklahoma

Statutes shall be construed to deem the following entities to be a

pharmacy benefits manager:

1. An employer of its own self-funded health benefit plan,

except, to the extent permitted by applicable law, where the

employer without the utilization of a third party and unrelated to

the employer’s own pharmacy:

a.

negotiates directly with drug manufacturers,

b.

processes claims on behalf of its members, or

c.

manages its own retail network of pharmacies; or

2. A pharmacy that provides a patient with a discount card or

program that is for exclusive use at the pharmacy offering the

discount.

Added by Laws 2019, c. 426, § 3, eff. Nov. 1, 2019. Amended by Laws

2022, c. 38, § 1, emerg. eff. April 21, 2022; Laws 2024, c. 306, §

1, emerg. eff. May 15, 2024; Laws 2025, c. 332, § 7, eff. Nov. 1,

2025.