{"data":{"id":"us-ok/okla.-stat.-tit.-59-59-357v2","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 59, § 59-357v2","heading":"Definitions","body":"A. As used in Sections 357 through 360 of this title:\n\n1. “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 benefit plan\n\nthat provides coverage only for accidental injury, specified\n\ndisease, hospital indemnity, disability income, or other limited\n\nbenefit health insurance policies and contracts that do not include\n\nprescription drug coverage;\n\n2. “Covered individual” means a member, participant, enrollee,\n\ncontract holder or policy holder or beneficiary of a covered entity\n\nwho is provided health coverage by the covered entity. A covered\n\nindividual includes any dependent or other person provided health\n\ncoverage through a policy, contract or plan for a covered\n\nindividual;\n\n3. “Department” means the Insurance Department;\n\n4. “Effective rate contracting” means any agreement or\n\narrangement between a pharmacy or contracting agent acting on behalf\n\nof a pharmacy and a pharmacy benefits manager for pharmaceuticals\n\nbased on the effective rate of payment rather than a predetermined\n\nfixed price or fixed discount percentage;\n\n5. “Maximum allowable cost”, “MAC”, or “MAC list” means the\n\nlist of drug products delineating the maximum per-unit reimbursement\n\nfor multiple-source prescription drugs, medical product, or device;\n\n6. “Multisource drug product reimbursement” (reimbursement)\n\nmeans the total amount paid to a pharmacy inclusive of any reduction\n\nin payment to the pharmacy, excluding prescription dispense fees and\n\nprofessional fees;\n\n7. “Office” means the Office of the Attorney General;\n\n8. “Pharmacy benefits management” means a service provided to\n\ncovered entities to facilitate the provision of prescription drug\n\nbenefits to covered individuals within the state, including\n\nnegotiating pricing and other terms with drug manufacturers and\n\nproviders. Pharmacy benefits management may include any or all of\n\nthe 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. clinical formulary development and management\n\nservices, or\n\nc. rebate contracting and administration;\n\n9. “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 an\n\nagency or department of this state;\n\n10. “Plan sponsor” means the employers, insurance companies,\n\nunions and health maintenance organizations or any other entity\n\nresponsible for establishing, maintaining, or administering a health\n\nbenefit plan on behalf of covered individuals; and\n\n11. “Provider” means a pharmacy licensed by the State Board of\n\nPharmacy, or an agent or representative of a pharmacy, including,\n\nbut not limited to, the pharmacy’s contracting agent, which\n\ndispenses prescription drugs or devices to covered individuals.\n\nB. Nothing in the definition of pharmacy benefits management or\n\npharmacy benefits manager in the Patient’s Right to Pharmacy Choice\n\nAct, Pharmacy Audit Integrity Act, or Sections 357 through 360 of\n\nthis title shall deem an employer a “pharmacy benefits manager” of\n\nits own self-funded health benefit plan, except, to the extent\nch\n\ndispenses prescription drugs or devices to covered individuals.\n\nB. Nothing in the definition of pharmacy benefits management or\n\npharmacy benefits manager in the Patient’s Right to Pharmacy Choice\n\nAct, Pharmacy Audit Integrity Act, or Sections 357 through 360 of\n\nthis title shall deem an employer a “pharmacy benefits manager” of\n\nits own self-funded health benefit plan, except, to the extent\n\npermitted by applicable law, where the employer, without the\n\nutilization of a third party and unrelated to the employer’s own\n\npharmacy:\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.","path":["OK Code","Title 59"],"source_url":"https://www.oklegislature.gov/OK_Statutes/CompleteTitles/os59.pdf","current_through":"2026-08-14","vintage":"open-us-law v2026.08, retrieved 2026-09-14","retrieved_at":"2026-09-14T18:32:36Z","sha256":"a3d83a32bce83ff67bf8f1b9fdd25bd48f8eade42dff8386c8465d62b3093eb4","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-59-59-357v1","next":"us-ok/okla.-stat.-tit.-59-59-358"},"notice":"GroundRules: Original legal text. Not legal advice."}