SB 993: Pharmacy benefit managers; establishing requirements and limits for certain audit reports and findings. Emergency. - Oklahoma

Floor (House) → Floor (Senate) · 5 edits

MODERATE

This bill updates the Pharmacy Audit Integrity Act to standardize definitions and streamline audit procedures for pharmacy benefits managers (PBMs). Key changes include clarifying what constitutes a 'disaster' to include events like wildfires and terrorist attacks, and establishing stricter notice periods for audits, requiring 30 days' notice for wholesale audits and 14 days for others. The bill also introduces protections against recoupment for minor clerical errors unless fraud is proven, aiming to reduce administrative burdens and prevent financial penalties for pharmacies over small mistakes.

Scope change

The bill expands the definition of 'disaster' to include a broader range of catastrophic events and clarifies the applicability of the Pharmacy Audit Integrity Act to various healthcare entities and third-party payors.

DEFINITION

Updated the definition of 'disaster declaration' to explicitly include events such as wildfires, terrorist attacks, and other catastrophic events alongside floods and tornadoes.

Clarified that 'pharmacy benefits manager' retains its existing legal meaning from Title 36 of the Oklahoma Statutes.

REQUIREMENT

Standardized audit notice requirements, mandating a minimum of 30 calendar days' written notice for wholesale purchase audits and 14 calendar days for other audit types.

ENFORCEMENT

Added protections preventing PBMs from recouping funds for clerical or record-keeping errors (e.g., typos, computer errors) unless there is proof of intent to commit fraud.

TECHNICAL

Removed House-specific formatting and legislative history text to align with the Senate floor version.

SB993 (3-18-25) (GOLLIHARE) FS FA1.PDF → Floor (House) · 3 edits

MINOR

The bill text was converted from a Senate floor substitute to a House committee substitute, adding specific formatting instructions for committee amendments. The substantive policy content regarding pharmacy audit definitions, procedures, and penalties appears unchanged in the provided text, though the formatting indicates this version includes additional amendments made by the House committee.

TECHNICAL

The document header was changed from 'FLOOR SUBSTITUTE' to 'COMMITTEE SUBSTITUTE' to reflect that the House has reviewed and amended the Senate version.

A note was added stating that 'BOLD FACE denotes Committee Amendments,' indicating that specific text formatting is used to highlight changes made by the House committee.

Page numbers and running headers were updated to reflect the House floor version (e.g., 'SB993 HFLR') instead of the Senate version.

Committee Substitute → SB993 (3-18-25) (GOLLIHARE) FS FA1.PDF · 4 edits

MODERATE

The bill was reclassified from a 'Committee Substitute' to a 'Floor Substitute' and the sponsor list was expanded to include additional legislators. The substantive policy text remains largely consistent, though the new version includes updated section references and a slightly revised summary of the act's purpose.

Scope change

The bill's scope of applicability to pharmacy audits and definitions remains unchanged; only the procedural status and sponsorship details were updated.

TECHNICAL

The bill title was changed from 'Committee Substitute' to 'Floor Substitute', indicating it has moved from committee review to floor consideration.

The list of sponsors was expanded to include 'Jech of the Senate' and 'Stinson of the House' in addition to Gollihare.

The summary of the act was updated to include additional sections (357, 358, and 360) and expanded descriptions of the act's provisions.

Page numbering and formatting markers were updated to reflect the new version of the document.

House Committee Substitute for Senate Bill → Committee Substitute · 6 edits

MODERATE

The bill was renumbered and streamlined to remove redundant legislative history. Substantively, it clarifies that the Pharmacy Audit Integrity Act applies to audits conducted by a wider range of entities, including third-party payors and state health programs. It also strengthens protections for pharmacies by explicitly excluding clerical errors from fraud accusations and recoupment, unless there is proof of intentional fraud.

Scope change

The scope of audits subject to the law was expanded to include third-party payors, health programs administered by state departments, and entities representing these groups, in addition to managed care companies and insurance companies.

DEFINITION

Added a new definition for 'Pharmacy benefits manager' to ensure consistency with existing state statutes.

SCOPE

Expanded the list of entities subject to the audit integrity rules to include third-party payors and state-administered health programs.

REQUIREMENT

Extended the required notice period for wholesale purchase audits from 14 days to 30 days.

Mandated that audits involving clinical judgment must be conducted in consultation with a licensed pharmacist.

ENFORCEMENT

Added a specific exemption preventing the recoupment of funds for clerical or record-keeping errors unless the PBM can prove intent to commit fraud.

TECHNICAL

Removed redundant text regarding the bill's origin and previous committee substitutions.

Proposed Committee Substitute (full committee) 1 → House Committee Substitute for Senate Bill · 4 edits

MODERATE

The bill was amended to replace the entire text with a revised version that adds specific protections for pharmacies during audits. The most significant change is the new requirement that audits involving clinical judgment must be conducted with a licensed pharmacist and that clerical errors must not be treated as fraud.

Scope change

The bill's scope was updated to include new procedural requirements for audits and expanded definitions regarding error handling, while the original title and committee designation were removed.

REQUIREMENT

Added a new requirement that any audit involving clinical or professional judgment must be conducted in consultation with a licensed pharmacist.

ENFORCEMENT

Added a new provision stating that clerical or record-keeping errors, such as typos or computer glitches, cannot be considered fraud and cannot result in financial recoupment.

TECHNICAL

Removed the original 'Proposed Oversight Committee Substitute' title and header information.

Updated the document reference number from 13499 to 13515.

Enrolled (final version) → Proposed Committee Substitute (full committee) 1 · 1 edit

MINOR

The bill was completely rewritten from scratch by the House committee, replacing the original Senate version. While the core subject matter regarding pharmacy audits remains similar, the committee version reorganized the statutory language, updated page references, and standardized the formatting of definitions and requirements. No substantive policy changes, such as new rules, fines, or deadlines, were introduced in this specific markup.

Scope change

The bill's scope and applicability remain unchanged; it still governs pharmacy benefits manager audits in Oklahoma.

TECHNICAL

The entire text of the bill was replaced with a new version that reorganized the structure and standardized the formatting of definitions and statutory sections.

Engrossed → Enrolled (final version) · 1 edit · May 22, 2025

MINOR

The bill transitioned from an 'Engrossed' draft to the final 'Enrolled' version, incorporating minor formatting adjustments and clarifying language. The core policy content regarding pharmacy audit definitions, notice requirements, and fraud exemptions remains substantively identical to the previous version, with no new substantive laws, funding changes, or altered timelines introduced in this specific update.

TECHNICAL

Minor formatting and structural changes were applied to standardize the bill's layout, such as updating the header from 'ENGROSSED SENATE' to 'ENROLLED SENATE' and adjusting line breaks for the final print version.

Amended And Engrossed → Engrossed · 5 edits · May 14, 2025

MODERATE

The bill was renumbered from an 'Engrossed House Amendment' to an 'Engrossed Senate Bill,' indicating the Senate version became the final text. Substantively, the bill amends the Pharmacy Audit Integrity Act to clarify definitions, limit audit scope to specific activities, and establish strict timelines for audits and appeals.

Scope change

The bill's scope remains focused on regulating pharmacy benefits managers (PBMs) and their audits of pharmacies, but the applicability is refined to exclude certain clerical errors from fraud accusations and to specify notice periods for different audit types.

TECHNICAL

The document title and header were changed from 'Engrossed House Amendment' to 'Engrossed Senate Bill,' reflecting the final legislative version.

DEFINITION

The definition of 'disaster' was updated to include specific catastrophic events like wildfires and terrorist attacks, ensuring the law applies clearly during various emergencies.

REQUIREMENT

New requirements mandate that PBMs give at least 14 days' notice for general audits and 30 days for wholesale purchase audits, with specific rules for rescheduling.

Audit procedures are now required to be conducted in consultation with a licensed pharmacist for any matter involving clinical or professional judgment.

ENFORCEMENT

The bill explicitly states that clerical errors, such as typos or computer mistakes, cannot be treated as fraud or result in financial recoupment from pharmacies.

Introduced → Amended And Engrossed · 4 edits · May 14, 2025

MODERATE

The bill was amended to update the list of statutes it modifies to include Section 360, clarify definitions regarding audits and disasters, and adjust procedural requirements for audits and appeals. These changes ensure the legislation aligns with the most recent statutory framework and provides clearer guidance on how audits are conducted and disputes are resolved.

Scope change

The bill's scope was expanded to explicitly include amendments to Section 360 of the Oklahoma Statutes, covering pharmacy benefits manager contractual duties, in addition to the previously listed sections.

DEFINITION

The definition of 'Audit' was updated to explicitly state it is conducted by a 'pharmacy benefits manager (PBM)' or its representative, and the definition of 'Disaster declaration' was streamlined for clarity.

REQUIREMENT

The requirement for prescription claim documentation was clarified to ensure it does not exceed state or federal laws, and the text was corrected to avoid redundancy regarding record-keeping.

SCOPE

The legislative text was updated to include Section 360 of the Oklahoma Statutes in the list of sections being amended, expanding the bill's statutory reach.

TECHNICAL

Minor formatting and phrasing adjustments were made throughout the bill to improve readability and consistency with standard legislative drafting practices.

Pharmacy benefit managers; establishing requirements and limits for certain audit reports and findings. Emergency.

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