SB 2007

                      An Act
ENROLLED SENATE
BILL NO. 2007  By: Wingard, Bullard, and Burns
                                            of the Senate
                                                   and
                                            Stinson, West (Tammy), and
                                            Archer of the House
       An Act relating to pharmacy benefits managers;
       amending 59 O.S. 2021, Section 360, as last amended
       by Section 8, Chapter 300, O.S.L. 2025 (59 O.S. Supp.
       2025, Section 360), which relates to pharmacy
       benefits manager contractual duties to provider;
       requiring pharmacy benefits manager to remit certain
       fees in certain situations; updating statutory
       language; and providing an effective date.
SUBJECT:   Pharmacy benefits managers
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
    SECTION 1.     AMENDATORY     59 O.S. 2021, Section 360, as last
amended by Section 8, Chapter 300, O.S.L. 2025 (59 O.S. Supp. 2025,
Section 360), is amended to read as follows:
    Section 360. A. The pharmacy benefits manager (PBM) shall,
with respect to contracts between a pharmacy benefits manager and a
provider, including a pharmacy service administrative organization:
    l. Include in such contracts the specific sources utilized to
determine the maximum allowable cost (MAC) pricing of the pharmacy,
update MAC pricing at least every seven (7) calendar days, and
establish a process for providers to readily access the MAC list
specific to that provider;
    2. In order to place a drug on the MAC list, ensure that the
drug is listed as “A” or “B” rated in the most recent version of the
United States Food and Drug Administration (FDA) Approved Drug
Products with Therapeutic Equivalence Evaluations, also known as the
Orange Book, and the drug is generally available for purchase by
pharmacies in the state from national or regional wholesalers and is
not obsolete;
    3. Ensure dispensing fees are not included in the calculation
of MAC price reimbursement to pharmacy providers;
    4. Provide a reasonable administration appeals procedure to
allow a provider, a provider’s representative and a pharmacy service
administrative organization to contest reimbursement amounts within
fourteen (14) calendar days of the final adjusted payment date. The
pharmacy benefits manager shall not prevent the pharmacy or the
pharmacy service administrative organization from filing
reimbursement appeals in an electronic batch format. The pharmacy
benefits manager must PBM shall respond to a provider, a provider’s
representative and a pharmacy service administrative organization
who have contested a reimbursement amount through this procedure
within ten (10) calendar days. The pharmacy benefits manager must
PBM shall respond in an electronic batch format to reimbursement
appeals filed in an electronic batch format. The pharmacy benefits
manager PBM shall not require a pharmacy or pharmacy services
administrative organization to log into a system to upload
individual claim appeals or to download individual appeal responses.
If a price update is warranted, the pharmacy benefits manager PBM
shall make the change in the reimbursement amount, permit the
dispensing pharmacy to reverse and rebill the claim in question, and
make the reimbursement amount change retroactive and effective for
all contracted providers;
    5. If a below-cost reimbursement appeal is denied, the PBM
shall provide the reason for the denial, including the National Drug
Code (NDC) number from, and the name of, the specific national or
regional wholesalers doing business in this state where the drug is
currently in stock and available for purchase by the dispensing
pharmacy at a price below the PBM’s reimbursement price. The PBM
shall include documented proof from the specific national or
regional wholesalers doing business in this state showing that the
drug is currently in stock and available for purchase by the
ENR. S. B. NO. 2007  Page 2
dispensing pharmacy at a price below the PBM’s reimbursement price.
If the NDC number provided by the pharmacy benefits manager PBM is
not available below the acquisition cost obtained from the
pharmaceutical wholesaler from whom the dispensing pharmacy
purchases the majority of the prescription drugs that are dispensed,
the pharmacy benefits manager PBM shall immediately adjust the
reimbursement amount, permit the dispensing pharmacy to reverse and
rebill the claim in question, and make the reimbursement amount
adjustment retroactive and effective for all contracted providers;
    6. If a PBM increases reimbursement for a drug, medical
product, or device as a result of an appeal pursuant to this
subsection, including an adjustment required pursuant to paragraph 5
of this subsection, and reduces the reimbursement amount for the
same drug, medical product, or device, including the same NDC
number, within thirty (30) calendar days of the appeal
determination, the PBM shall remit an administrative fee not less
than One Hundred Dollars ($100.00) to the affected provider for each
occurrence. If such fees are not remitted after ninety (90)
calendar days, the administrative fee shall not be less than Five
Hundred Dollars ($500.00) for each occurrence. If such fees are not
remitted after one hundred eighty (180) calendar days, the
administrative fee shall not be less than One Thousand Dollars
($1,000.00);
    7. Any appeal that results in an increase in the reimbursement
from the PBM that continues to be below the pharmacy’s acquisition
cost shall be considered a denial under this section. Any denial of
an appeal shall follow the requirements of paragraph paragraphs 5
and 6 of this subsection; and
    7. 8. The PBM shall not require a pharmacy to collect
additional monies following a successful below-cost reimbursement
appeal from any person or entity other than the PBM who adjudicated
the drug claim, including the patient or plan sponsor.
    B. The reimbursement appeal requirements in this section shall
apply to all drugs, medical products, or devices reimbursed
according to any payment methodology, including, but not limited to:
    1. Average acquisition cost, including the National Average
Drug Acquisition Cost;
ENR. S. B. NO. 2007  Page 3
   2.   Average manufacturer price;
   3.   Average wholesale price;
   4.   Brand effective rate or generic effective rate;
   5.   Discount indexing;
   6.   Federal upper limits;
   7.   Wholesale acquisition cost; and
    8. Any other term that a pharmacy benefits manager PBM or an
insurer of a health benefit plan may use to establish reimbursement
rates to a pharmacist or pharmacy for pharmacist services.
    C. The pharmacy benefits manager PBM shall not place a drug on
a MAC list, unless there are at least two therapeutically
equivalent, multiple-source drugs, generally available for purchase
by dispensing retail pharmacies from national or regional
wholesalers.
    D. In the event that a drug is placed on the FDA Drug Shortages
Database, pharmacy benefits managers PBMs shall reimburse claims to
pharmacies at no less than the wholesale acquisition cost for the
specific NDC number being dispensed.
    E. The pharmacy benefits manager PBM shall not require
accreditation or licensing of providers, or any entity licensed or
regulated by the State Board of Pharmacy, other than by the State
Board of Pharmacy or federal government entity as a condition for
participation as a network provider.
    F. A pharmacy or pharmacist may decline to provide the
pharmacist clinical or dispensing services to a patient or pharmacy
benefits manager if the pharmacy or pharmacist is to be paid less
than the pharmacy’s cost for providing the pharmacist clinical or
dispensing services.
ENR. S. B. NO. 2007  Page 4
    G. The pharmacy benefits manager PBM shall provide a dedicated
telephone number, email address and names of the personnel with
decision-making authority regarding MAC appeals and pricing.
   SECTION 2.   This act shall become effective November 1, 2026.
ENR. S. B. NO. 2007  Page 5
   Passed the Senate the 26th day of March, 2026.
                                   Presiding Officer of the Senate
   Passed the House of Representatives the 28th day of April, 2026.
                                    Presiding Officer of the House
                                                of Representatives
                       OFFICE OF THE GOVERNOR
   Received by the Office of the Governor this ____________________
day of ___________________, 20_______, at _______ o'clock _______ M.
By: _________________________________
   Approved by the Governor of the State of Oklahoma this _________
day of ___________________, 20_______, at _______ o'clock _______ M.
                                   _________________________________
                                   Governor of the State of Oklahoma
                  OFFICE OF THE SECRETARY OF STATE
   Received by the Office of the Secretary of State this __________
day of __________________, 20 _______, at _______ o'clock _______ M.
By: _________________________________
ENR. S. B. NO. 2007  Page 6