Healthcare

SB 1064 requires health insurance plans in Oklahoma to use evidence-based clinical guidelines when creating step therapy protocols (where insurers mandate trying cheaper drugs first). It mandates that insurers provide a clear, accessible process for doctors and patients to request exceptions when step therapy blocks necessary medications, and they must grant exceptions if the doctor provides justification (e.g., prior drug failure, adverse reactions, or medical necessity). Insurers must respond to exception requests within 72 hours (24 hours for emergencies), and failure to respond on time automatically grants the exception. The bill directly affects insurers, healthcare providers, and patients using prescription drugs covered under step therapy protocols.

SB 161 requires pharmacy benefit managers (PBMs) operating in the state to uphold a specific fiduciary duty. This means PBMs must act in the best interests of patients, not just their own financial gain, when making decisions about drug coverage and pricing. The bill establishes new rules for how PBMs manage prescription drug benefits, mandating transparency and prioritizing patient welfare. It directly affects all PBMs providing services to health plans within the state, changing their operational obligations under current law.