Okla. Admin. Code § 365:25-29-7.1
Current through Vol. 41, No. 19, June 17, 2024
Section 365:25-29-7.1 - Retail pharmacy network access - audit(a) Standards: (1) Section 6960 of the act defines "member of a retail pharmacy network" as meaning retail pharmacy providers contracted with a PBM on behalf of a payor in which the pharmacy primarily fills and sells prescription medicine via retail storefront location.(2) The act draws no distinction between regular or specialty drugs, both being prescription medications, therefore, specialty drugs fall within the contemplation of the act.(3) Pharmacy benefits managers shall not in any manner on any material, including but not limited to mail and ID cards, include the name of any pharmacy, hospital or other providers unless it specifically lists all pharmacies, hospitals and providers.(b) A PBM's retail pharmacy network access shall be monitored for compliance with this act by those insurers that utilize the services of such PBM. Health insurers are required to maintain retail pharmacy network access in conformity with the requirements set forth in § 6961 of this act.(c) Every Insurer that utilizes the services of a PBM shall, as part of the annual general compliance audit required by 365:25-29-9, conduct a network adequacy audit. If the audit reveals the percentage of covered individuals is less than one hundred and five percent (105%) above any of the required percentages in 36 O.S. § 6961 the insurer shall conduct semi-annual network adequacy audits until such time that an audit indicates that the percentage of covered individuals is more than five percent 5% above the required percentage.(d) The audits must be completed within ninety (90) days of the effective date of 36 O.S. § 6958-6968 and annually each year thereafter. The results of the audits shall be reported to the Commissioner within thirty (30) days of the completion of the audit.Okla. Admin. Code § 365:25-29-7.1
Adopted by Oklahoma Register, Volume 37, Issue 24, September 1, 2020, eff. 9/11/2020