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An Act
ENROLLED SENATE
BILL NO. 1500 By: Jech, Bullard, and Burns of
the Senate
and
Newton of the House
An Act relating to pharmacy benefits managers;
amending 59 O.S. 2021, Section 357, as last amended
by Section 2, Chapter 414, O.S.L. 2025 (59 O.S. Supp.
2025, Section 357), which relates to definitions;
defining terms; modifying definitions; updating
statutory references; updating statutory language;
prohibiting certain payment from being conditioned on
certain provisions; prohibiting certain provider from
bearing certain risks; requiring certain payor to
remit certain payment within certain time frame;
requiring certain payor to provide providers with
certain accounting; establishing certain requirements
for certain accounting; prohibiting certain payor
from certain actions; requiring certain payments made
outside of certain time frame to accrue interest;
authorizing the Attorney General to levy certain
fines; establishing certain contracts as void;
allowing the Attorney General to promulgate rules;
making certain claims applicable to certain
provisions; providing for codification; and providing
an effective date.
SUBJECT: Pharmacy benefits managers
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 59 O.S. 2021, Section 357, as last
amended by Section 2, Chapter 414, O.S.L. 2025 (59 O.S. Supp. 2025,
Section 357), is amended to read as follows:
ENR. S. B. NO. 1500 Page 2
Section 357. A. As used in Sections 357 through 360 360.1 of
this title:
1. “Clean claim” means a claim that is submitted in accordance
with all applicable billing requirements, contains all information
reasonably necessary for adjudication, and is not subject to an
unresolved eligibility or coverage dispute at the time of
submission;
2. “Claim” means a request for payment or reimbursement
submitted by a provider for prescription drugs, pharmacy-dispensed
medical supplies or devices, professional pharmacy services, or
manufacturer coupon, copay-assistance, discount card, or other
similar transactions;
3. “Covered entity” means a nonprofit hospital or medical
service organization, for-profit hospital or medical service
organization, insurer, health benefit plan, health maintenance
organization, health program administered by the state in the
capacity of providing health coverage, or an employer, labor union,
or other group of persons that provides health coverage to persons
in this state. This term does not include a health benefit plan
that provides coverage only for accidental injury, specified
disease, hospital indemnity, disability income, or other limited
benefit health insurance policies and contracts that do not include
prescription drug coverage;
2. 4. “Covered individual” means a member, participant,
enrollee, contract holder or policy holder or beneficiary of a
covered entity who is provided health coverage by the covered
entity. A covered individual includes any dependent or other person
provided health coverage through a policy, contract or plan for a
covered individual;
3. 5. “Department” means the Insurance Department;
4. 6. “Effective rate contracting” means any agreement or
arrangement between a pharmacy or contracting agent acting on behalf
of a pharmacy and a pharmacy benefits manager for pharmaceuticals
based on the effective rate of payment rather than a predetermined
fixed price or fixed discount percentage;
ENR. S. B. NO. 1500 Page 3
5. 7. “Maximum allowable cost”, “MAC”, or “MAC list” means the
list of drug products delineating the maximum per-unit reimbursement
for multiple-source prescription drugs, medical product products, or
device devices;
6. 8. “Multisource drug product reimbursement” (reimbursement)
means the total amount paid to a pharmacy inclusive of any reduction
in payment to the pharmacy, excluding prescription dispense fees and
professional fees;
7. 9. “Office” means the Office of the Attorney General;
8. 10. “Payor” means any person or entity that adjudicates
processes, administers, controls, or funds payment or reimbursement
of a pharmacy claim including, but not limited to:
a. pharmacy benefits managers,
b. health insurers,
c. health maintenance organizations,
d. third-party administrators,
e. self-funded or fully insured health benefit plans,
f. government health programs,
g. manufacturer coupon card, copay-assistance, or patient
assistance programs,
h. discount card, voucher, rebate, or similar program
administrators, and
i. any affiliate, agent, or contractor acting on behalf
of an entity provided in this paragraph.
Payor does not include a covered individual;
11. “Pharmacy benefits management” means a service provided to
covered entities to facilitate the provision of prescription drug
benefits to covered individuals within the state, including
ENR. S. B. NO. 1500 Page 4
negotiating pricing and other terms with drug manufacturers and
providers. Pharmacy benefits management may include any or all of
the following services:
a. claims processing, retail network management and
payment of claims to pharmacies for prescription drugs
dispensed to covered individuals,
b. clinical formulary development and management
services, or
c. rebate contracting and administration;
9. 12. “Pharmacy benefits manager” or “PBM” means a person,
business, or other entity that performs pharmacy benefits
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 an
agency or department of this state;
10. 13. “Plan sponsor” means the employers, insurance
companies, unions and health maintenance organizations or any other
entity responsible for establishing, maintaining, or administering a
health benefit plan on behalf of covered individuals; and
11. 14. “Provider” means a pharmacy licensed by the State Board
of Pharmacy, or an agent or representative of a pharmacy, including,
but not limited to, the pharmacy’s contracting agent, which
dispenses prescription drugs or devices to covered individuals; and
15. “Receipt” means the date on which a pharmacy claim is first
received by a payor or any agent of the payor, regardless of
internal routing or processing.
B. Nothing in the definition of pharmacy benefits management or
pharmacy benefits manager in the Patient’s Right to Pharmacy Choice
Act, Pharmacy Audit Integrity Act, or Sections 357 through 360 360.1
of this title shall deem an:
ENR. S. B. NO. 1500 Page 5
1. An employer a “pharmacy benefits manager” pharmacy benefits
manager of its own self-funded health benefit plan, except, to the
extent permitted by applicable law, where the employer, without the
utilization of a third party and unrelated to the employer’s own
pharmacy:
a. negotiates directly with drug manufacturers,
b. processes claims on behalf of its members, or
c. manages its own retail network of pharmacies; or
2. A covered entity or plan sponsor a pharmacy benefits manager
solely because such entity or sponsor retains ultimate authority to
establish, adopt, modify, or approve its own prescription drug
formulary, including utilization management criteria or negotiating
directly with drug manufacturers, while contracting with a pharmacy
benefits manager, third-party administrator, or other vendor to
administer, process, adjudicate, or pay pharmacy claims on the
entity’s or sponsor’s behalf, provided that:
a. the covered entity or plan sponsor retains final
decision-making authority over formulary design and
formulary changes including, but not limited to, the
power to reject any addition, removal, tiering change,
prior authorization requirement, step therapy
requirement, or other utilization management
requirement, and
b. the pharmacy benefits manager or other vendor acts in
an administrative capacity only with respect to claims
processing, adjudication, pharmacy network
administration, and payment functions, and does not
possess unilateral authority to change the formulary
other than implementing changes authorized by the
covered entity or plan sponsor.
SECTION 2. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 360.2 of Title 59, unless there
is created a duplication in numbering, reads as follows:
ENR. S. B. NO. 1500 Page 6
A. Payment to a provider for a claim shall not be conditioned
upon post-transaction reconciliation, manufacturer funding cycles,
or internal settlement between program sponsors, administrators, or
affiliates.
B. A provider shall not bear the risk of delayed or failed
funding between a manufacturer, administrator, or other third party
after a claim is adjudicated or accepted at the point of sale.
C. A payor shall remit full payment for a clean claim no later
than thirty (30) calendar days after the receipt of the clean claim.
Nothing in this subsection shall prohibit or discourage payment in a
shorter time period, including expedited payment of electronically
submitted claims.
D. A payor shall provide a provider with a clear, accurate, and
individualized accounting of all payments made to the provider for
claims. The accounting shall be provided in a readable, itemized
format, including electronic remittance advice or other electronic
format commonly used in the pharmacy industry, and shall not require
the provider to aggregate, infer, or reconstruct claim-level payment
information. Such accounting shall be provided with each payment or
remittance and shall be presented at a claim-by-claim level that
reasonably allows the provider to identify:
1. A unique claim identifier or prescription number;
2. The date of service or dispensing date;
3. The total amount paid for the claim by the payor;
4. The total amount paid for the claim by the covered
individual or plan member;
5. The total amount paid to the pharmacy for reimbursement;
6. Any amounts withheld, reduced, or adjusted, including the
reason for such adjustment;
7. Any fees, assessments, or offsets applied to the claim;
ENR. S. B. NO. 1500 Page 7
8. The identity of the payor or program responsible for the
payment, including identification of any manufacturer coupon, copay-
assistance, or discount card program involved;
9. The final payment date for the claim; and
10. Any interest paid on a claim pursuant to subsection F of
this section.
E. A payor shall not:
1. Bundle or net multiple claims in a manner that obscures
claim-level payment information;
2. Provide only summary, aggregate, or plan-level payment data
in lieu of individualized claim accounting;
3. Condition access to individualized claim accounting on
additional fees, portal subscriptions, or contractual waivers;
4. Delay payment of an adjudicated or accepted claim beyond the
time frames established pursuant to subsection C of this section;
5. Retroactively reprice, reverse, or withhold payment after
adjudication, except as otherwise expressly permitted by state law;
6. Condition or withhold payment based on audits conducted
after adjudication;
7. Extend payment timelines through contract, policy, program
terms, or operating rules inconsistent with subsection C of this
section; or
8. Shift payment risk to a provider due to internal disputes,
funding delays, or administrative issues of the payor or the payor’s
affiliates.
F. Any payment not made within the time frame set forth in
subsection C of this section shall automatically accrue interest
beginning on the day after the expiration of such time frame. Such
interest shall accrue at a rate of ten percent (10%) per thirty (30)
days, calculated solely on the unpaid amount owed by the payor to
ENR. S. B. NO. 1500 Page 8
the provider. Interest assessed pursuant to this subsection shall
be non-waivable and shall be paid in addition to the underlying
claim amount.
G. A payor may be subject to any fines, penalties, and remedies
provided by state law. The Attorney General may levy a civil or
administrative fine not less than One Hundred Dollars ($100.00) and
not more than Ten Thousand Dollars ($10,000.00) per each violation
of this act.
H. Any contract, agreement, policy, or program term that
waives, limits, or extends the rights or timelines established
pursuant to this act shall be void and unenforceable.
I. The Attorney General may promulgate any rules necessary to
enforce the provisions of this act.
J. This section shall be applicable to all claims paid on or
after the effective date of this act regardless of the date a
contract or program was executed or the payment methodology or
reimbursement model used by the payor.
SECTION 3. This act shall become effective November 1, 2026.
ENR. S. B. NO. 1500 Page 9
Passed the Senate the 26th day of March, 2026.
Presiding Officer of the Senate
Passed the House of Representatives the 30th day of April, 2026.
Presiding Officer of the House
of Representatives
OFFICE OF THE GOVERNOR
Received by the Office of the Governor this ____________________
day of ___________________, 20_______, at _______ o'clock _______ M.
By: _________________________________
Approved by the Governor of the State of Oklahoma this _________
day of ___________________, 20_______, at _______ o'clock _______ M.
_________________________________
Governor of the State of Oklahoma
OFFICE OF THE SECRETARY OF STATE
Received by the Office of the Secretary of State this __________
day of __________________, 20 _______, at _______ o'clock _______ M.
By: _________________________________