Okla. Stat. tit. 36, § 36-6965: Power and authority to investigate, examine, and enforce

A. The Attorney General shall have power and authority to

examine and investigate the affairs of every pharmacy benefits

manager (PBM) engaged in pharmacy benefits management in this state

in order to determine whether such entity is in compliance with 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.

B. The Attorney General shall have the power and authority to

subpoena witnesses and records, whether prior to or during an

investigation or prosecution of a complaint, from any relevant

entity or persons to ensure compliance with 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.

C. All PBM files and records shall be subject to examination by

the Attorney General or by duly appointed designees. The Attorney

General, authorized employees and examiners shall have access to any

of a PBM’s files and records that may relate to a particular

complaint under investigation or to an inquiry or examination by the

Attorney General.

D. Every officer, director, employee or agent of the PBM, upon

receipt of any inquiry from the Attorney General, shall, within

twenty (20) days from the date the inquiry is sent, furnish the

Attorney General with an adequate response to the inquiry.

E. When making an examination under this section, the Attorney

General may retain subject matter experts, attorneys, appraisers,

independent actuaries, independent certified public accountants or

an accounting firm or individual holding a permit to practice public

accounting, certified financial examiners or other professionals and

specialists as examiners, the cost of which shall be borne by the

PBM that is the subject of the examination.

F. 1. Protected health information (PHI) held by a PBM shall

be provided at the request of the Attorney General for the purpose

of conducting investigations into potential violations of state laws

and regulations related to the PBM. Disclosure of protected health

information shall be limited to the extent necessary for the

investigation and enforcement of state law.

2. All disclosures of protected health information shall be

made in compliance with all applicable federal and state privacy

laws, including the Health Insurance Portability and Accountability

Act of 1996 (HIPAA), and other relevant laws protecting the privacy

and confidentiality of health information.

3. Any protected health information obtained for an

investigation shall be handled and maintained per applicable federal

and state privacy laws and regulations, including HIPAA.

4. Unauthorized disclosure of protected health information

obtained during an investigation is strictly prohibited and subject

to legal penalties.

G. 1. If the Attorney General, after notice and opportunity

for hearing, finds that any PBM operating within this state has not

fully cooperated with an investigation or inquiry conducted by the

Attorney General related to compliance with 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, the Attorney

General may instruct the Insurance Commissioner that the PBM be

censured or his or her license be suspended or revoked. If the

Attorney General makes such instruction, the Commissioner shall

enforce the instructed action within thirty (30) days.

2. In addition to or in lieu of any censure, suspension, or

revocation by the Commissioner, the Attorney General may levy a

civil or administrative fine not less than One Hundred Dollars

($100.00) and not greater than Ten Thousand Dollars ($10,000.00) for

each violation of this subsection and assess any other penalty or

remedy authorized by this act. For purposes of this section, each

days.

2. In addition to or in lieu of any censure, suspension, or

revocation by the Commissioner, the Attorney General may levy a

civil or administrative fine not less than One Hundred Dollars

($100.00) and not greater than Ten Thousand Dollars ($10,000.00) for

each violation of this subsection and assess any other penalty or

remedy authorized by this act. For purposes of this section, each

day a PBM fails to comply with an investigation or inquiry may be

considered a separate violation.