HB 2048 - Prohibits Insurers and Pharmacy Benefit Managers From Discriminatory Reimbursement Actions, and Provides Definitions - Oklahoma Key Vote

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Title: Prohibits Insurers and Pharmacy Benefit Managers From Discriminatory Reimbursement Actions, and Provides Definitions

Vote Smart's Synopsis:

Vote to override a veto on a bill that prohibits insurers and pharmacy benefit managers from discriminatory reimbursement actions in Oklahoma.

Highlights:

  • Establishes the 340B Nondiscrimination Act, and provides the following definitions (Sec. 1-2):

    • Defines “340B drug” as a drug that has been subject to any offer for reduced prices by a manufacturer; and

    • Defines “340B entity” as an entity participating or authorized to participate in the federal 340B drug discount program.

  • Prohibits a health insurer, pharmacy benefits manager, other third-party payor, or its agent from the following (Sec. 3):

    • Reimbursing a 340B entity for 340B drugs at a rate lower than that paid for the same drug to non-340B entities;

    • Imposing terms or conditions on any 340B entity that differ from such terms for non-340B entities;

    • Requiring a 340B entity to reverse, resubmit, or clarify a claim related to 340B drug pricing;

    • Discriminating against a 340B entity in a manner that prevents or interferes with any patient’s choice to receive drugs from the 340B entity;

    • Requiring or compelling the submission of ingredient costs for 340B drugs; and

    • Excluding any 340B entity for reasons other than those that apply equally to non-340B entities.

  • Prohibits a manufacturer from denying, restricting, prohibiting, or otherwise interfering with the acquisition of a 340B drug by a 340B entity or pharmacy contracted with a 340B entity (Sec. 4).

  • Amends current code to prohibit pharmacy benefit managers from the following (Sec. 8):

    • Requiring a billing modifier to indicate that a drug or claim is a 340B drug pricing claim, unless it is billed to the Oklahoma Medicaid Program;

    • Modifying a patient copayment on the basis that the provider participates in 340B drug pricing; and

    • Excluding a provider from a network on the basis that it participates in 340B drug pricing.

See How Your Politicians Voted

Title: Prohibits Insurers and Pharmacy Benefit Managers From Discriminatory Reimbursement Actions, and Provides Definitions

Vote Smart's Synopsis:

Vote to override a veto on a bill that prohibits insurers and pharmacy benefit managers from discriminatory reimbursement actions in Oklahoma.

Highlights:

  • Establishes the 340B Nondiscrimination Act, and provides the following definitions (Sec. 1-2):

    • Defines “340B drug” as a drug that has been subject to any offer for reduced prices by a manufacturer; and

    • Defines “340B entity” as an entity participating or authorized to participate in the federal 340B drug discount program.

  • Prohibits a health insurer, pharmacy benefits manager, other third-party payor, or its agent from the following (Sec. 3):

    • Reimbursing a 340B entity for 340B drugs at a rate lower than that paid for the same drug to non-340B entities;

    • Imposing terms or conditions on any 340B entity that differ from such terms for non-340B entities;

    • Requiring a 340B entity to reverse, resubmit, or clarify a claim related to 340B drug pricing;

    • Discriminating against a 340B entity in a manner that prevents or interferes with any patient’s choice to receive drugs from the 340B entity;

    • Requiring or compelling the submission of ingredient costs for 340B drugs; and

    • Excluding any 340B entity for reasons other than those that apply equally to non-340B entities.

  • Prohibits a manufacturer from denying, restricting, prohibiting, or otherwise interfering with the acquisition of a 340B drug by a 340B entity or pharmacy contracted with a 340B entity (Sec. 4).

  • Amends current code to prohibit pharmacy benefit managers from the following (Sec. 8):

    • Requiring a billing modifier to indicate that a drug or claim is a 340B drug pricing claim, unless it is billed to the Oklahoma Medicaid Program;

    • Modifying a patient copayment on the basis that the provider participates in 340B drug pricing; and

    • Excluding a provider from a network on the basis that it participates in 340B drug pricing.

Title: Prohibits Insurers and Pharmacy Benefit Managers From Discriminatory Reimbursement Actions, and Provides Definitions

Title: Prohibits Insurers and Pharmacy Benefit Managers From Discriminatory Reimbursement Actions, and Provides Definitions

Title: Prohibits Insurers and Pharmacy Benefit Managers From Discriminatory Reimbursement Actions, and Provides Definitions

Title: Prohibits Insurers and Pharmacy Benefit Managers From Discriminatory Reimbursement Actions, and Provides Definitions

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