{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-6960","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-6960","heading":"Definitions","body":"A. For purposes of the Patient’s Right to Pharmacy Choice Act:\n\n1. “340B drug pricing” means the pricing agreement established\n\nunder Section 602 of the Veterans Health Care Act of 1992, Pub. L.\n\nNo. 102-585;\n\n2. “340B entity” means a covered entity as that term is defined\n\nin 42 U.S.C., Section 256b;\n\n3. “Covered entity” means a nonprofit hospital or medical\n\nservice organization, for-profit hospital or medical service\n\norganization, insurer, health benefit plan, health maintenance\n\norganization, health program administered by the state in the\n\ncapacity of providing health coverage, or an employer, labor union,\n\nor other group of persons that provides health coverage to persons\n\nin this state. This term does not include a health plan that\n\nprovides coverage only for accidental injury, specified disease,\n\nhospital indemnity, disability income, or other limited benefit\n\nhealth insurance policies and contracts that do not include\n\nprescription drug coverage;\n\n4. “Health insurer” means any corporation, association, benefit\n\nsociety, exchange, partnership or individual licensed by the\n\nOklahoma Insurance Code;\n\n5. “Health insurer payor” means a health insurance company,\n\nhealth maintenance organization, union, hospital and medical\n\nservices organization or any entity providing or administering a\n\nself-funded health benefit plan;\n\n6. “Mail-order pharmacy” means a pharmacy licensed by this\n\nstate that primarily dispenses and delivers covered drugs via common\n\ncarrier;\n\n7. “Pharmacy benefits manager” or “PBM” means a person,\n\nbusiness, or other entity that performs pharmacy benefits\n\nmanagement. The term shall include a person or entity acting on\n\nbehalf of a PBM in a contractual or employment relationship in the\n\nperformance of pharmacy benefits management for a managed care\n\ncompany, nonprofit hospital, medical service organization, insurance\n\ncompany, third-party payor or a health program administered by a\n\ndepartment of this state;\n\n8. “Pharmacy benefits management” means a service provided to\n\ncovered entities to facilitate the provisions of prescription drug\n\nbenefits to covered individuals within the state, including, but not\n\nlimited to, negotiating pricing and other terms with drug\n\nmanufacturers and providers. Pharmacy benefits management may\n\ninclude any or all of the following services:\n\na. claims processing, retail network management, and\n\npayment of claims to pharmacies for prescription drugs\n\ndispensed to covered individuals,\n\nb. administration or management of pharmacy discount\n\ncards or programs,\n\nc. clinical formulary development and management\n\nservices, or\n\nd. rebate contracting and administration;\n\n9. “Provider” means a pharmacy, as defined in Section 353.1 of\n\nTitle 59 of the Oklahoma Statutes or an agent or representative of a\n\npharmacy;\n\n10. “Retail pharmacy network” means retail pharmacy providers\n\ncontracted with a PBM in which the pharmacy primarily fills and\n\nsells prescriptions via a retail, storefront location;\n\n11. “Rural service area” means a five-digit ZIP code in which\n\nthe population density is less than one thousand (1,000) individuals\n\nper square mile;\n\n12. “Spread pricing” means a prescription drug pricing model\n\nutilized by a pharmacy benefits manager in which the PBM charges a\n\nhealth benefit plan a contracted price for prescription drugs that\n\ndiffers from the amount the PBM directly or indirectly pays the\n\npharmacy or pharmacist for providing pharmacy services;\n\n13. “Suburban service area” means a five-digit ZIP code in\n\nwhich the population density is between one thousand (1,000) and\n\nthree thousand (3,000) individuals per square mile; and\n\n14. “Urban service area” means a five-digit ZIP code in which\n\nthe population density is greater than three thousand (3,000)\n\nindividuals per square mile.\n\nB. Nothing in the definitions of pharmacy benefits manager or\n13. “Suburban service area” means a five-digit ZIP code in\n\nwhich the population density is between one thousand (1,000) and\n\nthree thousand (3,000) individuals per square mile; and\n\n14. “Urban service area” means a five-digit ZIP code in which\n\nthe population density is greater than three thousand (3,000)\n\nindividuals per square mile.\n\nB. Nothing in the definitions of pharmacy benefits manager or\n\npharmacy benefits management as such terms are defined in the\n\nPatient’s Right to Pharmacy Choice Act, the Pharmacy Audit Integrity\n\nAct, or Sections 357 through 360 of Title 59 of the Oklahoma\n\nStatutes shall be construed to deem the following entities to be a\n\npharmacy benefits manager:\n\n1. An employer of its own self-funded health benefit plan,\n\nexcept, to the extent permitted by applicable law, where the\n\nemployer without the utilization of a third party and unrelated to\n\nthe employer’s own pharmacy:\n\na. negotiates directly with drug manufacturers,\n\nb. processes claims on behalf of its members, or\n\nc. manages its own retail network of pharmacies; or\n\n2. A pharmacy that provides a patient with a discount card or\n\nprogram that is for exclusive use at the pharmacy offering the\n\ndiscount.","path":["OK Code","Title 36"],"source_url":"https://www.oklegislature.gov/OK_Statutes/CompleteTitles/os36.pdf","current_through":"2026-08-14","vintage":"open-us-law v2026.08, retrieved 2026-09-14","retrieved_at":"2026-09-14T18:32:36Z","sha256":"ac78c3194e1b32cb63bc2ea6327c3eeabea2595b58cfcc77e9211e343f55c982","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-6959","next":"us-ok/okla.-stat.-tit.-36-36-6961"},"notice":"GroundRules: Original legal text. Not legal advice."}