SB 804 requires Oklahoma assisted living centers to establish an internal quality assurance committee that meets quarterly. The committee must monitor incidents, resident satisfaction, and care quality - especially medication administration - and recommend policies, with membership including a registered nurse, administrator, direct care staff, and pharmacist as needed. The bill also updates existing rules to mandate monthly medication reviews by nurses/pharmacists, standardized resident screening, posting inspection results online, and individualized care plans. These changes directly affect all licensed assisted living centers in Oklahoma, effective November 1, 2025.
SB 574 expands the types of opioid-related projects eligible for state grant funding by allowing the Attorney General to allocate funds toward new prevention, treatment, and recovery initiatives. It directly affects state agencies and community organizations receiving opioid grants by broadening allowable uses beyond current restrictions. The bill authorizes the Attorney General to use grant funds for specific, previously ineligible activities, such as community-based support programs. This policy change modifies how opioid grant funds are distributed without altering the grant application process.
Oklahoma's SB 773 regulates pharmacy benefit managers (PBMs) by prohibiting unfair practices that affect independent pharmacies and patients. It requires PBMs to pay independent pharmacies the same reimbursement rate for identical drugs as they pay PBM-owned pharmacies, banning "spread pricing" where PBMs charge plans more than they pay pharmacies. The bill also prohibits PBMs from charging pharmacies fees for claim submission, network enrollment, or claims processing, and restricts retroactive payment reductions except for fraud or audit errors. These changes directly impact PBMs, pharmacies, and health plans operating in Oklahoma, aiming to ensure fairer payment practices. The bill was vetoed by the governor but overridden by the legislature on May 29, 2025.
HB 2048, the "340B Nondiscrimination Act," prohibits health insurers, pharmacy benefits managers (PBMs), and third-party payors from discriminating against healthcare providers participating in the federal 340B drug discount program. It specifically bans lower reimbursement rates for 340B drugs, extra fees or administrative burdens for 340B entities, exclusion from provider networks based on 340B status, and requirements to disclose 340B-specific billing details. The law applies to all 340B entities - such as community health centers and hospitals participating in the federal program - and ensures they receive equal treatment in billing, reimbursement, and network access. Enforcement is handled by the Attorney General, with the Oklahoma Medicaid program excluded from these provisions.
This bill requires Oklahoma health insurance plans to cover low-dose mammography screenings for breast cancer without cost-sharing (such as deductibles or copays). It mandates coverage once every five years for women aged 35-39 and annually for women 40 and older. The law also requires coverage for necessary diagnostic and supplemental breast exams, including those for high-risk cases like dense breast tissue. The policy takes effect November 1, 2025.
HB 1808, now law in Oklahoma, reforms health insurance prior authorization and step-therapy rules to improve patient access to medications. It requires insurers to grant exceptions to step-therapy protocols (where patients must try cheaper drugs first) if a medication is contraindicated, ineffective based on medical history, or causes harm - covering specific scenarios like prior adverse reactions or stability on a current treatment. The bill mandates insurers respond to urgent prior authorization requests within 24 hours and non-urgent requests within 2 business days, with requests deemed approved if deadlines are missed. It also ensures continuity of coverage for stable treatments when switching plans (90-day protection) and requires insurers to cover at least one readily available asthma controller medication per class without prior authorization.
SB 1135 allocates $100,000 from Oklahoma's General Revenue Fund to the Oklahoma Health Care Authority for the 2025-2026 fiscal year to support its operations. The bill declares an emergency to allow immediate implementation upon approval. This legislation provides specific funding for the Authority's duties without altering existing health insurance or tax policies.
SB 176 requires health insurance plans to cover certain prescription drugs that were previously not included in standard coverage. It directly affects health insurance providers and policyholders by mandating this specific coverage for eligible medications. The key provision is a new requirement for all health benefit plans to include these designated prescriptions without prior authorization or excessive cost-sharing. The law became effective on May 29, 2025, after the Governor did not sign it.
SB 146 expands mental wellness services provided by Oklahoma's Department of Public Safety to include retirees of public safety personnel (such as police and firefighters), in addition to current employees. It creates a dedicated revolving fund (Section 9102) to finance these services and strengthens privacy protections by prohibiting the sharing of individual mental health data without consent, while allowing aggregate data use for policy improvements (Section 9101). The bill also mandates that all Mental Wellness Division resources operate separately from other department divisions. These changes took effect November 1, 2025, after becoming law without the Governor's signature on May 29, 2025.
HB 2797 prohibits Oklahoma's Health Care Authority (OHCA) from using statistical methods like extrapolation to audit Medicaid home and community-based service claims, which could require providers to repay overpayments. It invalidates all past audits using these methods (January 2020-November 2025) and voids related repayment demands. The bill requires OHCA and the Department of Human Services to jointly develop new audit standards and provide training for providers by November 2027. It also mandates compliance with existing fraud reporting rules and updates audit responsibilities for Medicaid waiver programs.
