Sept. 29, 2021

Oklahoma Pharmacy Audit/Unfair Claims Settlement Mandates: HB 2677 & 2678

Applies to: Oklahoma Group and Retail plans

What you need to know. The 2021 Oklahoma Legislature passed House Bill 2677 and House Bill 2678 that relate to pharmacy claims.

HB 2677: Pharmacy Audit Integrity Act

• Sets limits on a Pharmacy Benefit Manager’s (PBM) pharmacy audit and recoupment practices 
• Sets audit and reimbursement appeal rights for the pharmacy 
• The law applies to PBMs and pharmacies in Oklahoma
• Impact: The requirement applies to the PBM and its pharmacy contracts and audit practices. There is no change to the benefit or pharmacy networks.
• Takes effect: Effective immediately as of May 4, 2021

HB 2678: Unfair Claims Settlement Act

• Member payments, including payments through use of a manufacturer coupon or copay card, must apply to the member’s out-of-pocket maximum (OOPM) or any other cost-sharing requirements 
• This requirement applies to a health insurer and/or a PBM 
• Applies to Retail and Group plans in Oklahoma, with the exception of ASO ERISA plans
• Impact: Member payments through use of a manufacturer coupon or copay card will now apply to the deductible and OOPM. This change will be reflected in benefit booklets.
• Takes effect: Effective Nov. 1, 2021, regardless of renewal date