Okla. Stat. tit. 36, § 36-6962

A. The Attorney General shall review and approve retail

pharmacy network access for all pharmacy benefits managers (PBMs) to

ensure compliance with Section 6961 of this title.

B. A PBM, or an agent of a PBM, shall not:

1. Cause or knowingly permit the use of advertisement,

promotion, solicitation, representation, proposal or offer that is

untrue, deceptive or misleading;

2. Charge a pharmacist or pharmacy a fee related to the

adjudication of a claim including without limitation a fee for:

a. the submission of a claim,

b. enrollment or participation in a retail pharmacy

network, or

c. the development or management of claims processing

services or claims payment services related to

participation in a retail pharmacy network;

3. Reimburse a pharmacy or pharmacist in the state an amount

less than the amount that the PBM reimburses a pharmacy owned by or

under common ownership with a PBM for providing the same covered

services. The reimbursement amount paid to the pharmacy shall be

equal to the reimbursement amount calculated on a per-unit basis

using the same generic product identifier or generic code number

paid to the PBM-owned or PBM-affiliated pharmacy;

4. Deny a provider the opportunity to participate in any

pharmacy network at preferred participation status if the provider

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is willing to accept the terms and conditions that the PBM has

established for other providers as a condition of preferred network

participation status;

5. Deny, limit or terminate a provider’s contract based on

employment status of any employee who has an active license to

dispense, despite probation status, with the State Board of

Pharmacy;

6. Retroactively deny or reduce reimbursement for a covered

service claim after returning a paid claim response as part of the

adjudication of the claim, unless:

a. the original claim was submitted fraudulently, or

b. to correct errors identified in an audit, so long as

the audit was conducted in compliance with Sections

356.2 and 356.3 of Title 59 of the Oklahoma Statutes;

7. Fail to make any payment due to a pharmacy or pharmacist for

covered services properly rendered in the event a PBM terminates a

provider from a pharmacy benefits manager network;

8. Conduct or practice spread pricing, as defined in Section

6960 of this title, in this state;

9. Charge a pharmacist or pharmacy a fee related to

participation in a retail pharmacy network including but not limited

to the following:

a. an application fee,

b. an enrollment or participation fee,

c. a credentialing or re-credentialing fee,

d. a change of ownership fee, or

e. a fee for the development or management of claims

processing services or claims payment services;

10. Discriminate, offer lower reimbursement, or impose any

separate terms upon a provider on the basis that a provider

participates in 340B drug pricing;

11. Require a provider to reverse, resubmit, or clarify a 340B

drug pricing claim after the initial adjudication unless these

actions are in the normal course of pharmacy business and not

related to 340B drug pricing;

12. Require a billing modifier to indicate that the drug or

claim is a 340B drug pricing claim, unless the drug or claim is

being billed to the Oklahoma Medicaid Program;

13. Modify a patient copayment on the basis that the provider

of the patient participates in 340B drug pricing;

14. Exclude a provider from a network on the basis that the

provider participates in 340B drug pricing;

15. Establish or set network adequacy requirements based on

340B drug pricing participation by a provider;

16. Prohibit a 340B entity or a pharmacy under contract with a

340B entity from participating in the network of the PBM on the

basis of participation in 340B drug pricing; or

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17. Base the drug formulary or drug coverage decisions upon the
5. Establish or set network adequacy requirements based on

340B drug pricing participation by a provider;

16. Prohibit a 340B entity or a pharmacy under contract with a

340B entity from participating in the network of the PBM on the

basis of participation in 340B drug pricing; or

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17. Base the drug formulary or drug coverage decisions upon the

340B drug pricing status of a drug, including price or availability,

or whether a dispensing pharmacy participates in 340B drug pricing.

C. The prohibitions under this section shall apply to contracts

between pharmacy benefits managers and providers for participation

in retail pharmacy networks.

1. A PBM contract shall:

a. not restrict, directly or indirectly, any pharmacy

that dispenses a prescription drug from informing, or

penalize such pharmacy for informing, an individual of

any differential between the individual’s out-of-

pocket cost or coverage with respect to acquisition of

the drug and the amount an individual would pay to

purchase the drug directly,

b. ensure that any entity that provides pharmacy benefits

management services under a contract with any such

health plan or health insurance coverage does not,

with respect to such plan or coverage, restrict,

directly or indirectly, a pharmacy that dispenses a

prescription drug from informing, or penalize such

pharmacy for informing, a covered individual of any

differential between the individual’s out-of-pocket

cost under the plan or coverage with respect to

acquisition of the drug and the amount an individual

would pay for acquisition of the drug without using

any health plan or health insurance coverage, and

c. eliminate discriminatory contracting as it relates to:

(1) transferring the benefit of 340B drug pricing

savings from a 340B entity to another entity,

including without limitation pharmacy benefits

managers, private insurers, and managed care

organizations,

(2) offering a lower reimbursement rate for drugs

purchased under 340B drug pricing than for the

same drug not purchased under 340B drug pricing,

(3) refusal to cover drug purchases utilizing 340B

drug pricing,

(4) refusal to allow providers who utilize 340B drug

pricing to participate in networks, and

(5) charging more than fair market value or seeking

profit sharing in exchange for services involving

340B drug pricing.

2. A pharmacy benefits manager’s contract with a provider shall

not prohibit, restrict, or limit disclosure of information or

documents to the Attorney General, law enforcement or state and

federal governmental officials investigating or examining a

complaint or conducting a review of a pharmacy benefits manager’s

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compliance with the requirements under the Patient’s Right to

Pharmacy Choice Act, the Pharmacy Audit Integrity Act, and Sections

357 through 360 of Title 59 of the Oklahoma Statutes.

D. A pharmacy benefits manager shall:

1. Establish and maintain an electronic claim inquiry

processing system using the National Council for Prescription Drug

Programs’ current standards to communicate information to pharmacies

submitting claim inquiries;

2. Fully disclose to insurers, self-funded employers, unions or

other PBM clients the existence of the respective aggregate

prescription drug discounts, rebates received from drug

manufacturers and pharmacy audit recoupments;

3. Provide the Attorney General, insurers, self-funded employer

plans and unions unrestricted audit rights of and access to the

respective PBM pharmaceutical manufacturer and provider contracts,

plan utilization data, plan pricing data, pharmacy utilization data

and pharmacy pricing data;

4. Maintain, for no less than three (3) years, documentation of

all network development activities including but not limited to

contract negotiations and any denials to providers to join networks.
d audit rights of and access to the

respective PBM pharmaceutical manufacturer and provider contracts,

plan utilization data, plan pricing data, pharmacy utilization data

and pharmacy pricing data;

4. Maintain, for no less than three (3) years, documentation of

all network development activities including but not limited to

contract negotiations and any denials to providers to join networks.

This documentation shall be made available to the Attorney General

upon request;

5. Report to the Attorney General, on a quarterly basis for

each health insurer payor, on the following information:

a. the aggregate amount of rebates received by the PBM,

b. the aggregate amount of rebates distributed to the

appropriate health insurer payor,

c. the aggregate amount of rebates passed on to the

enrollees of each health insurer payor at the point of

sale that reduced the applicable deductible,

copayment, coinsure or other cost sharing amount of

the enrollee,

d. the individual and aggregate amount paid by the health

insurer payor to the PBM for pharmacy services

itemized by pharmacy, drug product and service

provided, and

e. the individual and aggregate amount a PBM paid a

provider for pharmacy services itemized by pharmacy,

drug product and service provided;

6. Make drug formulary and coverage decisions based on the

normal course of business of the PBM, not based upon the 340B drug

pricing status of a drug, including price or availability, or

whether a dispensing pharmacy participates in 340B drug pricing.

E. Nothing in the Patient’s Right to Pharmacy Choice Act shall

prohibit the Attorney General from requesting and obtaining detailed

data, including raw data, in response to the information provided by

a PBM in the quarterly reports required by this section. The

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Attorney General may alter the frequency of the reports required by

this section at his or her sole discretion.

F. The Attorney General may promulgate rules to implement the

provisions of the Patient’s Right to Pharmacy Choice Act, the

Pharmacy Audit Integrity Act, and Sections 357 through 360 of Title

59 of the Oklahoma Statutes.