Okla. Stat. tit. 36, § 36-5402
This is the official text of Okla. Stat. tit. 36, § 36-5402, part of Oklahoma’s Stat. tit. 36, — part of the compiled statutory law of Oklahoma, published by the state as "Stat. tit. 36,." Browse the sections below, each linked to its official government source.
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Reimbursement to 340B entities — Restrictions
Official statutory text
A. With respect to reimbursement to a 340B entity for 340B
drugs, a health insurance issuer, pharmacy benefits manager, other
third-party payor, or its agent shall not:
1. Reimburse a 340B entity for 340B drugs at a rate lower than
that paid for the same drug to entities that are not 340B entities
or lower reimbursement for a claim on the basis that the claim is
for a 340B drug;
2. Impose any terms or conditions on any 340B entity with
respect to any of the following that differ from such terms or
conditions applied to non-340B entities on the basis that the entity
participates in the federal 340B drug discount program set forth in
Section 256b of Title 42 of the United States Code or that a drug is
a 340B drug including, without limitation, any of the following:
a. fees, charges, clawbacks, or other adjustments or
assessments. For purposes of this subsection, the
term "other adjustments" includes placing any
additional requirements, restrictions, or unnecessary
burdens upon the 340B entity that result in
administrative costs or fees to the 340B entity that
are not placed upon other entities that do not
participate in the 340B drug discount program,
including affiliate pharmacies of the health insurance
issuer, pharmacy benefits manager, or other third-
party payor,
b. dispensing fees that are less than the dispensing fees
for non-340B entities,
Oklahoma Statutes - Title 36. Insurance Page 1055
c. restrictions or requirements regarding participation
in standard or preferred pharmacy networks,
d. requirements relating to the frequency or scope of
audits of inventory management systems,
e. requirements that a claim for a drug include any
identification, billing modifier, attestation, or
other indication that a drug is a 340B drug in order
to be processed or resubmitted unless it is required
by the Centers for Medicare and Medicaid Services or
the Oklahoma Health Care Authority for the
administration of the Oklahoma Medicaid program, or
f. any other restrictions, conditions, practices, or
policies that are not imposed on non-340B entities;
3. Require a 340B entity to reverse, resubmit, or clarify a
claim after the initial adjudication unless these actions are in the
normal course of pharmacy business and not related to 340B drug
pricing;
4. Discriminate against a 340B entity in a manner that prevents
or interferes with any patient's choice to receive such drugs from
the 340B entity, including the administration of such drugs. For
purposes of this subsection, it is considered a discriminatory
practice that prevents or interferes with a patient's choice to
receive drugs at a 340B entity if a health insurance issuer,
pharmacy benefits manager, or other third-party payor places any
additional requirements, restrictions, or unnecessary burdens upon
the 340B entity that results in administrative costs or fees to the
340B entity, including but not limited to, requiring a claim for a
drug to include any identification, billing modifier, attestation,
or other indication that a drug is a 340B drug in order to be
processed or resubmitted unless it is required by the Centers for
Medicare and Medicaid Services or the Oklahoma Health Care Authority
in administration of the Oklahoma Medicaid program;
5. Include any other provision in a contract between a health
insurance issuer, pharmacy benefits manager, or other third-party
payor and a 340B entity that discriminates against the 340B entity
or prevents or interferes with an individual's choice to receive a
prescription drug from a 340B entity, including the administration
of the drug, in person or via direct delivery, mail, or other form
of shipment, or creation of a restriction or additional charge on a
patient who chooses to receive drugs from a 340B entity;
6. Require or compel the submission of ingredient costs or
pricing data pertaining to 340B drugs to any health insurance
e to receive a
prescription drug from a 340B entity, including the administration
of the drug, in person or via direct delivery, mail, or other form
of shipment, or creation of a restriction or additional charge on a
patient who chooses to receive drugs from a 340B entity;
6. Require or compel the submission of ingredient costs or
pricing data pertaining to 340B drugs to any health insurance
issuer, pharmacy benefits manager, or other third-party payor; or
7. Exclude any 340B entity from the health insurance issuer,
pharmacy benefits manager, or other third-party payor network on the
basis that the 340B entity dispenses drugs subject to an agreement
under Section 256b of Title 42 of the United States Code, or
Oklahoma Statutes - Title 36. Insurance Page 1056
refusing to contract with a 340B entity for reasons other than those
that apply equally to non-340B entities.
B. Nothing in this section applies to the Oklahoma Medicaid
program as payor when Medicaid provides reimbursement for covered
outpatient drugs as defined in Section 1396r-8(k) of Title 42 of the
United States Code.
drugs, a health insurance issuer, pharmacy benefits manager, other
third-party payor, or its agent shall not:
1. Reimburse a 340B entity for 340B drugs at a rate lower than
that paid for the same drug to entities that are not 340B entities
or lower reimbursement for a claim on the basis that the claim is
for a 340B drug;
2. Impose any terms or conditions on any 340B entity with
respect to any of the following that differ from such terms or
conditions applied to non-340B entities on the basis that the entity
participates in the federal 340B drug discount program set forth in
Section 256b of Title 42 of the United States Code or that a drug is
a 340B drug including, without limitation, any of the following:
a. fees, charges, clawbacks, or other adjustments or
assessments. For purposes of this subsection, the
term "other adjustments" includes placing any
additional requirements, restrictions, or unnecessary
burdens upon the 340B entity that result in
administrative costs or fees to the 340B entity that
are not placed upon other entities that do not
participate in the 340B drug discount program,
including affiliate pharmacies of the health insurance
issuer, pharmacy benefits manager, or other third-
party payor,
b. dispensing fees that are less than the dispensing fees
for non-340B entities,
Oklahoma Statutes - Title 36. Insurance Page 1055
c. restrictions or requirements regarding participation
in standard or preferred pharmacy networks,
d. requirements relating to the frequency or scope of
audits of inventory management systems,
e. requirements that a claim for a drug include any
identification, billing modifier, attestation, or
other indication that a drug is a 340B drug in order
to be processed or resubmitted unless it is required
by the Centers for Medicare and Medicaid Services or
the Oklahoma Health Care Authority for the
administration of the Oklahoma Medicaid program, or
f. any other restrictions, conditions, practices, or
policies that are not imposed on non-340B entities;
3. Require a 340B entity to reverse, resubmit, or clarify a
claim after the initial adjudication unless these actions are in the
normal course of pharmacy business and not related to 340B drug
pricing;
4. Discriminate against a 340B entity in a manner that prevents
or interferes with any patient's choice to receive such drugs from
the 340B entity, including the administration of such drugs. For
purposes of this subsection, it is considered a discriminatory
practice that prevents or interferes with a patient's choice to
receive drugs at a 340B entity if a health insurance issuer,
pharmacy benefits manager, or other third-party payor places any
additional requirements, restrictions, or unnecessary burdens upon
the 340B entity that results in administrative costs or fees to the
340B entity, including but not limited to, requiring a claim for a
drug to include any identification, billing modifier, attestation,
or other indication that a drug is a 340B drug in order to be
processed or resubmitted unless it is required by the Centers for
Medicare and Medicaid Services or the Oklahoma Health Care Authority
in administration of the Oklahoma Medicaid program;
5. Include any other provision in a contract between a health
insurance issuer, pharmacy benefits manager, or other third-party
payor and a 340B entity that discriminates against the 340B entity
or prevents or interferes with an individual's choice to receive a
prescription drug from a 340B entity, including the administration
of the drug, in person or via direct delivery, mail, or other form
of shipment, or creation of a restriction or additional charge on a
patient who chooses to receive drugs from a 340B entity;
6. Require or compel the submission of ingredient costs or
pricing data pertaining to 340B drugs to any health insurance
e to receive a
prescription drug from a 340B entity, including the administration
of the drug, in person or via direct delivery, mail, or other form
of shipment, or creation of a restriction or additional charge on a
patient who chooses to receive drugs from a 340B entity;
6. Require or compel the submission of ingredient costs or
pricing data pertaining to 340B drugs to any health insurance
issuer, pharmacy benefits manager, or other third-party payor; or
7. Exclude any 340B entity from the health insurance issuer,
pharmacy benefits manager, or other third-party payor network on the
basis that the 340B entity dispenses drugs subject to an agreement
under Section 256b of Title 42 of the United States Code, or
Oklahoma Statutes - Title 36. Insurance Page 1056
refusing to contract with a 340B entity for reasons other than those
that apply equally to non-340B entities.
B. Nothing in this section applies to the Oklahoma Medicaid
program as payor when Medicaid provides reimbursement for covered
outpatient drugs as defined in Section 1396r-8(k) of Title 42 of the
United States Code.
Status: in_force · Read it on the official government site
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