Senate Passes Wingard Bill Holding PBMs Accountable for Unfair Practices

OKLAHOMA CITY — The Oklahoma Senate on Thursday overwhelmingly passed legislation from Sen. Jonathan Wingard, R-Ada, to financially penalize pharmacy benefit managers that undercut reimbursement rates for local pharmacies.

Wingard said Oklahoma pharmacists and their employees spend a significant amount of time each week trying to appeal reimbursement rates for prescription medications. Data provided by the Oklahoma Attorney General’s Office indicates that Oklahoma pharmacists have appealed over 145,000 reimbursements so far this year, for an average of about 500 appeals per pharmacy.

“Pharmacies are losing time and money constantly appealing unfair reimbursement rates,” Wingard said. “This bill encourages PBMs to reimburse pharmacies for what’s truly owed the first time around. Under this legislation, companies that continue to delay or shortchange providers will be held accountable for their actions.”

Senate Bill 2007 requires PBMs to pay pharmacies a fee if they increase their reimbursement after a successful appeal. PBMs would be required to pay an administrative fee of $100 for each occurrence. If the PBM takes more than 90 calendar days to pay the fees, the penalties increase to $500 per occurrence. After 180 calendar days, the fees increase to $1,000 per occurrence.

PBMs are essentially middlemen that manage prescription drug benefits for insurance companies and employers by negotiating drug prices and reimbursement rates. Typically, their business tactics and motives are driven by profits, not necessarily what’s best for consumers or local health care providers.

“PBMs’ bad business practices are driving local pharmacies out of business at an alarming rate, which is deeply concerning for the future of rural health care,” Wingard said. “On average, pharmacies lose $40 to $50 per prescription because of unreasonably low reimbursements. Those margins are simply unsustainable for small businesses.”

SB 2007 passed the Senate 38-1. It now advances to the House, where it is carried by Rep. Preston Stinson, R-Edmond.

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For more information, contact: Communications@oksenate.gov