managers — White bagged drugs. A. As used in this section: 1. "Health benefit plan" means a health benefit plan as defined pursuant to Section 6060.4 in Title 36 of the Oklahoma Statutes; 2. "Pharmacy benefits manager" means a person that performs pharmacy benefits management and any other person acting for such person under a contractual or employment relationship in the performance of pharmacy benefits management for a managed-care company, not-for-profit hospital, medical services organization, insurance company, third-party payor, or a health program administered by a state agency; and 3. "White bagged drugs" means the distribution of physician administered medication from a pharmacy, typically a specialty pharmacy, to the physician's office, hospital, or clinic for administration. B. All health benefit plans and pharmacy benefits managers in this state shall not refuse to authorize, approve, or pay a participating provider for providing covered physician-administered drugs to covered persons. C. All white bagged drugs distributed in this state shall meet supply chain security controls set forth by the federal Drug Supply Chain Security Act as amended. D. A health benefit plan or a pharmacy benefits manager of a plan shall not require a covered patient to self-administer an injectable drug against a health care provider's recommendation in accordance with the manufacturer's approved guidelines. E. Health benefit plans shall not require a covered patient to pay additional fees for white bagged drugs beyond cost-sharing obligations as outlined in the individual's plan. F. Providers and health care facilities shall be permitted to dispense and administer a covered physician-administered drug based on a patient's best interest, provided that the health care facility or provider that administers the drug shall agree to the terms and conditions of network participation and accept, as payment in full, reimbursement for the drug at the health insurer's negotiated contracted rate. The health care facility or provider is prohibited from billing or collecting from the patient any amount in excess of or in addition to the patient's cost sharing obligations as outlined in the individual's plan. G. Any payor in violation of this act shall be fined a minimum of Five Thousand Dollars ($5,000.00) per violation, but not more than Ten Thousand Dollars ($10,000.00) per violation. Fines related to this section shall not be used when calculating payors, plans, or members loss ratios and losses incurred pursuant to this subsection shall not be passed on to the consumer in future rate increases.
‹ Prev All Oklahoma sections Next ›
Lexace provides legal information, not legal advice, and no attorney–client relationship is created. Statute text is provided for general information and may not reflect the most recent amendments; verify against the official state code.