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ENGR. H. B. NO. 4457 Page 1
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ENGROSSED HOUSE
BILL NO. 4457 By: Newton and Deck of the
House
and
Jech of the Senate
An Act relating to pharmacy benefits manager;
defining terms; prohibiting pharmacy benefits
managers from doing certain acts; requiring pharmacy
benefits managers to offer certain things; providing
for enforcement by the Attorney General; providing
for promulgation of rules; providing for
codification; and providing an effective date.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 6958.1 of Title 36, unless there
is created a duplication in numbering, reads as follows:
A. As used in this section:
1. "Health insurer" means any corporation, association, benefit
society, exchange, partnership or individual licensed by the
Oklahoma Insurance Code;
2. "Network pharmacy" means pharmacy providers contracted with
a pharmacy benefits manager;
3. "Pharmacy benefits manager" or "PBM" means a person,
business, or other entity that performs pharmacy benefits
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management. The term shall include a person or entity acting on
behalf of a PBM in a contractual or employment relationship in the
performance of pharmacy benefits management for a managed care
company, nonprofit hospital, medical service organization, insurance
company, third-party payor or a health program administered by a
department of this state;
4. "Medically integrated pharmacy" means a pharmacy that:
a. is owned by, affiliated with, or under common
ownership with a specialty provider or specialty
provider practice,
b. is physically or operationally integrated within the
clinical practice of the specialty provider,
c. is licensed and in good standing with the Oklahoma
State Board of Pharmacy, and
d. employs at least one pharmacist licensed in this state
to dispense prescription medications;
5. "Specialty medication" means a prescription drug that:
a. is used to treat complex, chronic, or rare medical
conditions and requires specialized handling,
administration, monitoring, or patient management, or
b. is classified or designated as a specialty medication
by the pharmacy benefits manager or the health benefit
plan; and
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6. "Specialty provider" means a licensed physician that
provides ongoing specialized medical treatment requiring complex
medication management, including but not limited to providers
practicing in the fields of oncology, urology, neurology,
nephrology, dermatology, cardiology, anesthesiology, or orthopedics.
B. A pharmacy benefits manager shall not:
1. Restrict, limit, or prohibit a covered person from obtaining
a specialty medication from a medically integrated pharmacy
affiliated with the covered person's treating specialty provider;
provided, that the pharmacy is licensed and in good standing with
the Oklahoma State Board of Pharmacy;
2. Require that a covered person obtain a specialty medication
exclusively through a pharmacy owned by, affiliated with, or
designated by the PBM when the covered person's treating specialty
provider maintains a medically integrated pharmacy capable of
dispensing the medication;
3. Discriminate against or disadvantage a medically integrated
pharmacy in the terms and conditions of network participation;
4. Impose additional or more stringent administrative
requirements on a medically integrated pharmacy that are not equally
imposed on other network pharmacies dispensing specialty
medications;
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5. Deny, reduce, or delay reimbursement for a specialty
medication solely because the medication is dispensed by a medically
integrated pharmacy;
6. Require a specialty provider or covered person to transfer a
valid prescription to another pharmacy as a condition of coverage or
reimbursement;
7. Impose differential copayments, coinsurance, or other cost-
sharing on a covered person based solely on the pharmacy from which
the specialty medication is obtained;
8. Engage in patient steering or any practice that has the
effect of directing patients away from a medically integrated
pharmacy to a PBM-owned, -affiliated, or -preferred pharmacy; and
9. Implement any policy, prior authorization requirement, step
therapy protocol, or utilization management practice that has the
effect of preventing a specialty provider from dispensing
medications necessary to ensure continuity of care, reduce
unnecessary treatment delays.
C. A PBM shall offer a medically integrated pharmacy the same
opportunity to participate in specialty pharmacy networks as is
offered to any other pharmacy. Any reimbursement rate, fee
schedule, audit standard, credentialing requirement, or contractual
term applied by a PBM to a medically integrated pharmacy shall be no
less favorable than those applied to any PBM-owned, -affiliated, or
-preferred specialty pharmacy.
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D. When a specialty provider is actively managing a covered
person's treatment plan, including monitoring for adverse effects,
drug interactions, or therapeutic outcomes, the PBM shall permit the
covered person to obtain specialty medications from the specialty
provider's medically integrated pharmacy. Nothing in this
subsection shall be construed to require a PBM to cover a drug that
is not otherwise covered by the health insurer.
E. A violation of this section shall constitute an unfair or
deceptive act and shall be subject to enforcement by the Attorney
General. The Attorney General shall promulgate rules as necessary
to implement and enforce the provisions of this section.
SECTION 2. This act shall become effective November 1, 2026.
Passed the House of Representatives the 23rd day of March, 2026.
Presiding Officer of the House
of Representatives
Passed the Senate the _____ day of _______, 2026.
Presiding Officer of the Senate