{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-6962","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-6962","heading":"Compliance review","body":"A. The Attorney General shall review and approve retail\n\npharmacy network access for all pharmacy benefits managers (PBMs) to\n\nensure compliance with Section 6961 of this title.\n\nB. A PBM, or an agent of a PBM, shall not:\n\n1. Cause or knowingly permit the use of advertisement,\n\npromotion, solicitation, representation, proposal or offer that is\n\nuntrue, deceptive or misleading;\n\n2. Charge a pharmacist or pharmacy a fee related to the\n\nadjudication of a claim including without limitation a fee for:\n\na. the submission of a claim,\n\nb. enrollment or participation in a retail pharmacy\n\nnetwork, or\n\nc. the development or management of claims processing\n\nservices or claims payment services related to\n\nparticipation in a retail pharmacy network;\n\n3. Reimburse a pharmacy or pharmacist in the state an amount\n\nless than the amount that the PBM reimburses a pharmacy owned by or\n\nunder common ownership with a PBM for providing the same covered\n\nservices. The reimbursement amount paid to the pharmacy shall be\n\nequal to the reimbursement amount calculated on a per-unit basis\n\nusing the same generic product identifier or generic code number\n\npaid to the PBM-owned or PBM-affiliated pharmacy;\n\n4. Deny a provider the opportunity to participate in any\n\npharmacy network at preferred participation status if the provider\n\nis willing to accept the terms and conditions that the PBM has\n\nestablished for other providers as a condition of preferred network\n\nparticipation status;\n\n5. Deny, limit or terminate a provider’s contract based on\n\nemployment status of any employee who has an active license to\n\ndispense, despite probation status, with the State Board of\n\nPharmacy;\n\n6. Retroactively deny or reduce reimbursement for a covered\n\nservice claim after returning a paid claim response as part of the\n\nadjudication of the claim, unless:\n\na. the original claim was submitted fraudulently, or\n\nb. to correct errors identified in an audit, so long as\n\nthe audit was conducted in compliance with Sections\n\n356.2 and 356.3 of Title 59 of the Oklahoma Statutes;\n\n7. Fail to make any payment due to a pharmacy or pharmacist for\n\ncovered services properly rendered in the event a PBM terminates a\n\nprovider from a pharmacy benefits manager network;\n\n8. Conduct or practice spread pricing, as defined in Section\n\n6960 of this title, in this state;\n\n9. Charge a pharmacist or pharmacy a fee related to\n\nparticipation in a retail pharmacy network including but not limited\n\nto the following:\n\na. an application fee,\n\nb. an enrollment or participation fee,\n\nc. a credentialing or re-credentialing fee,\n\nd. a change of ownership fee, or\n\ne. a fee for the development or management of claims\n\nprocessing services or claims payment services;\n\n10. Discriminate, offer lower reimbursement, or impose any\n\nseparate terms upon a provider on the basis that a provider\n\nparticipates in 340B drug pricing;\n\n11. Require a provider to reverse, resubmit, or clarify a 340B\n\ndrug pricing claim after the initial adjudication unless these\n\nactions are in the normal course of pharmacy business and not\n\nrelated to 340B drug pricing;\n\n12. Require a billing modifier to indicate that the drug or\n\nclaim is a 340B drug pricing claim, unless the drug or claim is\n\nbeing billed to the Oklahoma Medicaid Program;\n\n13. Modify a patient copayment on the basis that the provider\n\nof the patient participates in 340B drug pricing;\n\n14. Exclude a provider from a network on the basis that the\n\nprovider participates in 340B drug pricing;\n\n15. Establish or set network adequacy requirements based on\n\n340B drug pricing participation by a provider;\n\n16. Prohibit a 340B entity or a pharmacy under contract with a\n\n340B entity from participating in the network of the PBM on the\n\nbasis of participation in 340B drug pricing; or\n\n17. Base the drug formulary or drug coverage decisions upon the\n5. Establish or set network adequacy requirements based on\n\n340B drug pricing participation by a provider;\n\n16. Prohibit a 340B entity or a pharmacy under contract with a\n\n340B entity from participating in the network of the PBM on the\n\nbasis of participation in 340B drug pricing; or\n\n17. Base the drug formulary or drug coverage decisions upon the\n\n340B drug pricing status of a drug, including price or availability,\n\nor whether a dispensing pharmacy participates in 340B drug pricing.\n\nC. The prohibitions under this section shall apply to contracts\n\nbetween pharmacy benefits managers and providers for participation\n\nin retail pharmacy networks.\n\n1. A PBM contract shall:\n\na. not restrict, directly or indirectly, any pharmacy\n\nthat dispenses a prescription drug from informing, or\n\npenalize such pharmacy for informing, an individual of\n\nany differential between the individual’s out-of-\n\npocket cost or coverage with respect to acquisition of\n\nthe drug and the amount an individual would pay to\n\npurchase the drug directly,\n\nb. ensure that any entity that provides pharmacy benefits\n\nmanagement services under a contract with any such\n\nhealth plan or health insurance coverage does not,\n\nwith respect to such plan or coverage, restrict,\n\ndirectly or indirectly, a pharmacy that dispenses a\n\nprescription drug from informing, or penalize such\n\npharmacy for informing, a covered individual of any\n\ndifferential between the individual’s out-of-pocket\n\ncost under the plan or coverage with respect to\n\nacquisition of the drug and the amount an individual\n\nwould pay for acquisition of the drug without using\n\nany health plan or health insurance coverage, and\n\nc. eliminate discriminatory contracting as it relates to:\n\n(1) transferring the benefit of 340B drug pricing\n\nsavings from a 340B entity to another entity,\n\nincluding without limitation pharmacy benefits\n\nmanagers, private insurers, and managed care\n\norganizations,\n\n(2) offering a lower reimbursement rate for drugs\n\npurchased under 340B drug pricing than for the\n\nsame drug not purchased under 340B drug pricing,\n\n(3) refusal to cover drug purchases utilizing 340B\n\ndrug pricing,\n\n(4) refusal to allow providers who utilize 340B drug\n\npricing to participate in networks, and\n\n(5) charging more than fair market value or seeking\n\nprofit sharing in exchange for services involving\n\n340B drug pricing.\n\n2. A pharmacy benefits manager’s contract with a provider shall\n\nnot prohibit, restrict, or limit disclosure of information or\n\ndocuments to the Attorney General, law enforcement or state and\n\nfederal governmental officials investigating or examining a\n\ncomplaint or conducting a review of a pharmacy benefits manager’s\n\ncompliance with the requirements under the Patient’s Right to\n\nPharmacy Choice Act, the Pharmacy Audit Integrity Act, and Sections\n\n357 through 360 of Title 59 of the Oklahoma Statutes.\n\nD. A pharmacy benefits manager shall:\n\n1. Establish and maintain an electronic claim inquiry\n\nprocessing system using the National Council for Prescription Drug\n\nPrograms’ current standards to communicate information to pharmacies\n\nsubmitting claim inquiries;\n\n2. Fully disclose to insurers, self-funded employers, unions or\n\nother PBM clients the existence of the respective aggregate\n\nprescription drug discounts, rebates received from drug\n\nmanufacturers and pharmacy audit recoupments;\n\n3. Provide the Attorney General, insurers, self-funded employer\n\nplans and unions unrestricted audit rights of and access to the\n\nrespective PBM pharmaceutical manufacturer and provider contracts,\n\nplan utilization data, plan pricing data, pharmacy utilization data\n\nand pharmacy pricing data;\n\n4. Maintain, for no less than three (3) years, documentation of\n\nall network development activities including but not limited to\n\ncontract negotiations and any denials to providers to join networks.\nd audit rights of and access to the\n\nrespective PBM pharmaceutical manufacturer and provider contracts,\n\nplan utilization data, plan pricing data, pharmacy utilization data\n\nand pharmacy pricing data;\n\n4. Maintain, for no less than three (3) years, documentation of\n\nall network development activities including but not limited to\n\ncontract negotiations and any denials to providers to join networks.\n\nThis documentation shall be made available to the Attorney General\n\nupon request;\n\n5. Report to the Attorney General, on a quarterly basis for\n\neach health insurer payor, on the following information:\n\na. the aggregate amount of rebates received by the PBM,\n\nb. the aggregate amount of rebates distributed to the\n\nappropriate health insurer payor,\n\nc. the aggregate amount of rebates passed on to the\n\nenrollees of each health insurer payor at the point of\n\nsale that reduced the applicable deductible,\n\ncopayment, coinsure or other cost sharing amount of\n\nthe enrollee,\n\nd. the individual and aggregate amount paid by the health\n\ninsurer payor to the PBM for pharmacy services\n\nitemized by pharmacy, drug product and service\n\nprovided, and\n\ne. the individual and aggregate amount a PBM paid a\n\nprovider for pharmacy services itemized by pharmacy,\n\ndrug product and service provided;\n\n6. Make drug formulary and coverage decisions based on the\n\nnormal course of business of the PBM, not based upon the 340B drug\n\npricing status of a drug, including price or availability, or\n\nwhether a dispensing pharmacy participates in 340B drug pricing.\n\nE. Nothing in the Patient’s Right to Pharmacy Choice Act shall\n\nprohibit the Attorney General from requesting and obtaining detailed\n\ndata, including raw data, in response to the information provided by\n\na PBM in the quarterly reports required by this section. The\n\nAttorney General may alter the frequency of the reports required by\n\nthis section at his or her sole discretion.\n\nF. The Attorney General may promulgate rules to implement the\n\nprovisions of the Patient’s Right to Pharmacy Choice Act, the\n\nPharmacy Audit Integrity Act, and Sections 357 through 360 of Title\n\n59 of the Oklahoma Statutes.","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":"9e3bd627028898c426a823b567fd8934b9d462666d0735c0db42c2846e1564a6","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-6961","next":"us-ok/okla.-stat.-tit.-36-36-6963"},"notice":"GroundRules: Original legal text. Not legal advice."}