July 29, 2020

UPDATE: Status of Patient’s Right to Pharmacy Choice Act

 

The Patient’s Right to Pharmacy Choice Act (“Act”) was passed by the Oklahoma legislature in 2019 with a stated purpose to establish minimum and uniform access by patients to pharmacy providers. Among other things, the Act provides for network adequacy, transparency, and uniformity. The Insurance Commissioner was tasked with the responsibility to enforce the Act.

Since the Act has been in effect it has been the subject of litigation in federal court, Pharmaceutical Care Management Association, v. Glen Mulready and Oklahoma Insurance Department, Case No. CIV-19-77-J pending in the United States District Court for the Western District of Oklahoma, which has prevented the Commissioner from moving forward with enforcement. However, on July 9, 2020, Judge Jones of the federal district court for the Western District of Oklahoma ruled the Commissioner could proceed with enforcement of the majority of the provisions of the Act. PCMA has appealed that ruling to the 10th Circuit Court of Appeals in Denver.

The Commissioner will now proceed forward with enforcement of the Act, currently excluding Medicare Advantage and Medicare Part D plans per the Court’s order. The Commissioner has been maintaining a record of all complaints received, to-date there are approximately 180. The majority of those complaints relate to MAC list pricing and “choice of pharmacy concerns.” The Oklahoma Insurance Department has begun the process of investigating complaints received, and based upon such investigations, will proceed to take necessary action as authorized by the Act.

Stakeholders can expect to see violations, established through investigation, prosecuted through public hearings, conducted pursuant to the Oklahoma Administrative Procedures Act, 75 O.S. §§ 250 et seq. The Oklahoma Insurance Department’s enforcement will remain compliant with Judge Jones’ order and any future ruling by the 10th Circuit.

Section 6933 of the Act created an Advisory Committee made up of  seven appointees;  two people nominated by the Oklahoma Pharmacists Association, two consumer members not employed or related to insurance, pharmacy or PBM nominated  by the Governor’s office, two persons representing PBM or insurance industry nominated by the Insurance Commissioner, and one person representing the Office of the Attorney General nominated by the Attorney General. The purpose of the Committee is to assist the Commissioner’s regulatory activities by bringing the viewpoints of various constituencies represented by the committee to the Department. On July 9, 2020, the Commissioner welcomed the advisory committee at its first meeting held at the offices of the Insurance Commissioner, 400 NE 50th Street, Oklahoma City, OK  73105.  Mr. Ron White, Director of the Department’s PRPCA Division, briefed the committee on the Commissioner’s thoughts concerning enforcement and strategized with the Committee concerning “next steps”.

Questions or comments should be directed to
Ron White, Director of PBM Regulatory Compliance
Ronald.White@oid.ok.gov | (918) 295-3716