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 makes broad changes to Oklahoma’s pharmacy benefit manager (PBM) and pharmacy audit laws. It tightens audit procedures by requiring advance notice, limiting the scope and timing of audits, capping the number of prescription claims that may be audited each year, requiring pharmacists to be allowed to correct clerical errors without recoupment absent proof of fraud, and setting deadlines for preliminary and final audit reports and appeals. It also requires auditors to use pharmacists for clinical-judgment issues, refund patient-paid amounts first when recoupments occur, and void audits that do not comply with the statute if the Attorney General so finds.
The bill also revises PBM contracting and reimbursement rules. It expands and clarifies definitions related to covered entities, PBMs, plan sponsors, and effective rate contracting, while prohibiting effective rate contracting altogether. It requires PBMs to disclose MAC pricing sources, update MAC lists every seven days, provide a process for appeals, and justify below-cost reimbursement denials with specific wholesaler availability information. The bill further restricts how PBMs may lease or rent networks, bars combining ERISA and non-ERISA or government and nongovernment plans in certain leased-network arrangements, and states that these provisions cannot be waived by contract. The act takes effect November 1, 2025.
SB789 amends three sections of Title 59 governing pharmacy audits, PBM definitions, and PBM reimbursement practices. It strengthens statutory protections for pharmacies during audits, limits recoupment and audit discretion, and imposes new procedural and disclosure obligations on PBMs and audit vendors. It also creates enforceable rules around maximum allowable cost pricing, reimbursement appeals, network leasing, and effective rate contracting, with potential penalties for violations and Attorney General oversight for invalid audits.
The bill appears to have strong bipartisan and institutional support. It advanced through Senate and House committees and floor votes with overwhelming margins, including several unanimous votes and only one recorded no vote in committee. The voting pattern suggests broad agreement with the bill’s pharmacy-protection and PBM-regulation goals, with little visible opposition in the available record.
The main policy tensions in SB789 center on PBM business practices versus pharmacy reimbursement protections. Supporters likely view the bill as addressing audit abuse, opaque MAC pricing, and below-cost reimbursement, while critics may be concerned that the bill imposes rigid pricing rules, limits contractual flexibility, and increases compliance burdens on PBMs and plan sponsors. The prohibition on effective rate contracting, the ban on combining certain plan types in leased-network arrangements, and the limits on audit recoupments are the most significant points of potential contention.