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.

Status: in_force · Read it on the official government site

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