1| STATE OF OKLAHOMA | | | 2| 1st Session of the 60th Legislature (2025) | | | 3|SENATE BILL 34 By: Hicks | | | 4| | | | 5| | | | 6| AS INTRODUCED | | | 7| An Act relating to prescription drugs; creating the | | Access to Lifesaving Medicines Act; providing short | 8| title; defining terms; prohibiting certain insurers | | and pharmacy benefits managers from imposing certain | 9| costs; requiring certain rebates be offered to | | certain health benefit plans; establishing terms of | 10| prescription drug cost sharing; directing | | promulgation of rules; providing for noncodification; | 11| providing for codification; and providing an | | effective date. | 12| | | | 13| | | | 14|BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA: | | | 15| SECTION 1. NEW LAW A new section of law not to be | | | 16|codified in the Oklahoma Statutes reads as follows: | | | 17| This act shall be known and may be cited as the "Access to | | | 18|Lifesaving Medicines Act". | | | 19| SECTION 2. NEW LAW A new section of law to be codified | | | 20|in the Oklahoma Statutes as Section 6970 of Title 36, unless there | | | 21|is created a duplication in numbering, reads as follows: | | | 22| As used in this section: | | | 23| 1. "Adjusted out-of-pocket amount" means the copayment, | | | 24|coinsurance, or other cost-sharing obligation that a health benefit | | | Req. No. 679 Page 1 ___________________________________________________________________________
1|plan requires an insured to pay at the point of sale for a covered | | | 2|prescription medication otherwise payable, less the pro rata portion | | | 3|of any discounts, rebates, and price concessions in connection with | | | 4|the prescription drug; | | | 5| 2. "Claim" means any bill, claim, or proof of loss made by or | | | 6|on behalf of an insured or a provider to a health insurer or its | | | 7|intermediary, administrator, or representative, with which the | | | 8|provider has a provider contract for payment for health care | | | 9|services under any health benefit plan; | | | 10| 3. "Excess cost burden" means any copayments, coinsurance, or | | | 11|other cost-sharing an insured is required to pay at the point of | | | 12|sale to receive a prescription drug or device that exceeds the | | | 13|health insurer's or pharmacy benefits manager's net cost after | | | 14|applying a pro rata portion of any discounts, rebates, or | | | 15|concessions received from manufacturers, pharmacies, or other third | | | 16|parties; | | | 17| 4. "Health benefit plan" means a health benefit plan as defined | | | 18|pursuant to Section 6060.4 of Title 36 of the Oklahoma Statutes; | | | 19| 5. "Health care provider" or "provider" means a health care | | | 20|provider as defined pursuant to Section 3090.2 of Title 63 of the | | | 21|Oklahoma Statutes; | | | 22| 6. "Health insurer" means any entity subject to the | | | 23|jurisdiction of the Insurance Department and the insurance laws and | | | 24|regulations of this state that contracts or offers to contract to | | | Req. No. 679 Page 2 ___________________________________________________________________________
1|provide, deliver, arrange for, pay for, or reimburse any of the | | | 2|costs of health care services including, but not limited to, a | | | 3|health maintenance organization, a health benefit plan, or any other | | | 4|entity providing a plan of health insurance, health benefits, or | | | 5|health care services; | | | 6| 7. "Maximum allowable claim" means the amount the health | | | 7|insurer or pharmacy benefits manager has agreed to pay a pharmacy; | | | 8| 8. "Maximum allowable cost" means the maximum dollar amount | | | 9|that a health insurer or its intermediary will reimburse a pharmacy | | | 10|provider for a group of drugs rated as "A", "AB", "NR", or "NA" in | | | 11|the most recent edition of the Approved Drug Products with | | | 12|Therapeutic Equivalence Evaluations, published by the United States | | | 13|Food and Drug Administration, or similarly rated by a nationally | | | 14|recognized reference; | | | 15| 9. "Pharmacy" means a pharmacy as defined pursuant to Section | | | 16|353.1 of Title 59 of the Oklahoma Statutes; | | | 17| 10. "Pharmacy benefits manager" means a pharmacy benefits | | | 18|manager as defined pursuant to Section 6960 of Title 36 of the | | | 19|Oklahoma Statutes; | | | 20| 11. "Point of sale" means the transaction in which goods or | | | 21|services including, but not limited to, prescription medications, | | | 22|medical devices, and medical supplies are sold to the consumer; | | | 23| 12. "Rebate" means: | | | 24| | | | Req. No. 679 Page 3 ___________________________________________________________________________
1| a. negotiated price concessions including, but not | | | 2| limited to, base rebates and reasonable estimates of | | | 3| any price protection rebates and performance-based | | | 4| rebates that may accrue, directly or indirectly, to | | | 5| the health insurer or pharmacy benefits manager as a | | | 6| result of point-of-sale prescription medication claims | | | 7| processing during the coverage year from a | | | 8| manufacturer, dispensing pharmacy, or other party to | | | 9| the transaction, or | | | 10| b. reasonable estimates of any fees and other | | | 11| administrative costs that are passed through to the | | | 12| health insurer as a result of point-of-sale | | | 13| prescription medication claims processing and serve to | | | 14| reduce the health insurer's prescription medication | | | 15| liabilities for the coverage year; and | | | 16| 13. "Provider contract" means any contract between a health | | | 17|care provider and a health insurer, or an insurer's network, | | | 18|provider panel, intermediary, or representative, relating to the | | | 19|provision of health care services. | | | 20| B. Any health insurer or pharmacy benefits manager that issues, | | | 21|renews, or amends a health benefit plan with prescription drug | | | 22|coverage shall not impose an excess cost burden on an insured. | | | 23| C. When contracting with a health insurer or health benefit | | | 24|plan to administer pharmacy benefits, a pharmacy benefits manager | | | Req. No. 679 Page 4 ___________________________________________________________________________
1|shall offer the health benefit plan the option of extending | | | 2|point-of-sale rebates to enrollees of the plan. | | | 3| D. Prescription drug cost-sharing for an insured shall be the | | | 4|lesser of: | | | 5| 1. The applicable copayment for the prescription medication | | | 6|that would be payable in the absence of this section; | | | 7| 2. The maximum allowable cost; | | | 8| 3. The maximum allowable claim; | | | 9| 4. The adjusted out-of-pocket amount as determined pursuant to | | | 10|this section; | | | 11| 5. The amount an insured would pay for the prescription | | | 12|medication if the insured purchased it without using his or her | | | 13|health benefit plan or any other source of prescription medication | | | 14|benefits or discounts; or | | | 15| 6. The amount the pharmacy will be reimbursed for the | | | 16|prescription medication by the health insurer or pharmacy benefits | | | 17|manager. | | | 18| E. The Insurance Commissioner shall promulgate rules to | | | 19|effectuate the provisions of this section. | | | 20| SECTION 3. This act shall become effective November 1, 2025. | | | 21| | | | 22| 60-1-679 CAD 12/17/2024 3:52:48 PM | | | 23| | | | 24| | | | Req. No. 679 Page 5