Pharmacy benefit managers; permitting use of certain records without limitations of date or source for certain purposes; establishing certain reimbursement rates for certain drugs. Effective date.
SB789 revises Oklahoma law governing pharmacy audits and pharmacy benefit managers (PBMs). On the audit side, it tightens notice, documentation, timing, and reporting requirements for entities auditing pharmacies; limits audits to 50 prescriptions per year; bars recoupment for clerical or record-keeping errors absent proof of intent to commit fraud; requires auditors to use pharmacists for clinical judgment issues; and allows pharmacies to rely on broader categories of records, including hospital, physician, and purchase records, to validate claims. It also requires prompt preliminary and final audit reports, limits interest accrual during the audit/appeal period, and provides that audits failing to comply with the statute may be voided by the Attorney General.
The bill also makes major changes to PBM reimbursement and contracting rules. It defines and regulates maximum allowable cost (MAC) pricing, requires more frequent MAC updates, limits which drugs may be placed on MAC lists, and strengthens appeal procedures for pharmacies challenging reimbursement amounts. It prohibits effective rate contracting, bars contract terms from waiving the statute’s protections, and restricts PBMs from combining ERISA and non-ERISA or government and non-government plans when leasing or sharing networks. It further requires PBMs to disclose network and claim-processing information, and in certain shortage situations to reimburse at no less than wholesale acquisition cost.
In practical terms, SB789 expands statutory protections for pharmacies and pharmacists and increases compliance obligations for PBMs, auditors, and plan sponsors. It affects the Pharmacy Audit Integrity Act and related PBM provisions in Title 59, changing how audits are conducted, what evidence may be used, how disputes are handled, and how reimbursement rates are set and challenged. The bill is scheduled to take effect November 1, 2025.
The overall sentiment reflected in the voting history is strongly supportive and largely bipartisan. The bill passed both chambers with overwhelming margins, including unanimous or near-unanimous committee and floor votes, indicating broad agreement on the need to curb aggressive audit practices and improve pharmacy reimbursement transparency. The only recorded opposition was a single no vote in one House committee action.
The main points of contention are the bill’s restrictions on PBM business practices and its limits on audit recoupments. Supporters appear to view these changes as necessary consumer- and pharmacy-protection measures, while potential critics would likely focus on reduced PBM flexibility, tighter limits on audit recovery, and the prohibition on effective rate contracting. The bill text itself does not include detailed debate, but the structure of the measure suggests the central policy dispute is between pharmacy fairness and PBM cost-management authority.
SB789 amends 59 O.S. Sections 356.2, 357, and 360, substantially expanding statutory protections for pharmacies in audits and PBM reimbursement disputes. It changes audit procedures, evidence rules, recoupment limits, and appeal timelines, and it adds enforceable restrictions on PBM contracting, MAC pricing, network leasing, and effective rate contracting. These changes directly affect pharmacies, PBMs, insurers, plan sponsors, third-party payors, and state enforcement through the Attorney General and Insurance Department.
The bill appears to have enjoyed strong, broad support throughout the legislative process. Committee and floor votes in both chambers were overwhelmingly favorable, with no recorded floor opposition and only one dissenting committee vote. That voting pattern suggests lawmakers largely agreed with the bill’s goal of protecting pharmacies from burdensome audits and improving reimbursement practices.
The primary controversy is the bill’s regulation of PBMs and auditors. Supporters likely argue that the bill prevents unfair recoupments, improves transparency, and ensures pharmacies are paid appropriately for dispensing drugs. Opponents or skeptics would likely object to the prohibition on effective rate contracting, the limits on audit scope and recoupment, the restrictions on combining plan types, and the requirement that PBMs justify reimbursement rates with specific wholesaler availability data. These provisions shift leverage away from PBMs and toward pharmacies and plan sponsors, which is the central policy tension in the measure.