Oklahoma § 36-6969 - Restrictions on health benefit plans and pharmacy benefit

§ 36-6969. Restrictions on health benefit plans and pharmacy benefit

managers — White bagged drugs.

A. As used in this section:

1. "Health benefit plan" means a health benefit plan as defined

pursuant to Section 6060.4 in Title 36 of the Oklahoma Statutes;

2. "Pharmacy benefits manager" means a person that performs

pharmacy benefits management and any other person acting for such

person under a contractual or employment relationship in the

performance of pharmacy benefits management for a managed-care

company, not-for-profit hospital, medical services organization,

insurance company, third-party payor, or a health program

administered by a state agency; and

3. "White bagged drugs" means the distribution of physician

administered medication from a pharmacy, typically a specialty

pharmacy, to the physician's office, hospital, or clinic for

administration.

B. All health benefit plans and pharmacy benefits managers in

this state shall not refuse to authorize, approve, or pay a

Oklahoma Statutes - Title 36. Insurance

participating provider for providing covered physician-administered

drugs to covered persons.

C. All white bagged drugs distributed in this state shall meet

supply chain security controls set forth by the federal Drug Supply

Chain Security Act as amended.

D. A health benefit plan or a pharmacy benefits manager of a

plan shall not require a covered patient to self-administer an

injectable drug against a health care provider's recommendation in

accordance with the manufacturer's approved guidelines.

E. Health benefit plans shall not require a covered patient to

pay additional fees for white bagged drugs beyond cost-sharing

obligations as outlined in the individual's plan.

F. Providers and health care facilities shall be permitted to

dispense and administer a covered physician-administered drug based

on a patient's best interest, provided that the health care facility

or provider that administers the drug shall agree to the terms and

conditions of network participation and accept, as payment in full,

reimbursement for the drug at the health insurer's negotiated

contracted rate. The health care facility or provider is prohibited

from billing or collecting from the patient any amount in excess of

or in addition to the patient's cost sharing obligations as outlined

in the individual's plan.

G. Any payor in violation of this act shall be fined a minimum

of Five Thousand Dollars ($5,000.00) per violation, but not more

than Ten Thousand Dollars ($10,000.00) per violation. Fines related

to this section shall not be used when calculating payors, plans, or

members loss ratios and losses incurred pursuant to this subsection

shall not be passed on to the consumer in future rate increases.

Added by Laws 2024, c. 185, § 1, emerg. eff. April 29, 2024.