A.With respect to reimbursement to a 340B entity for 340B drugs, a health insurance issuer, pharmacy benefits manager, other third-party payor, or its agent shall not: 1. Reimburse a 340B entity for 340B drugs at a rate lower than that paid for the same drug to entities that are not 340B entities or lower reimbursement for a claim on the basis that the claim is for a 340B drug; 2. Impose any terms or conditions on any 340B entity with respect to any of the following that differ from such terms or conditions applied to non-340B entities on the basis that the entity participates in the federal 340B drug discount program set forth in Section 256b of Title 42 of the United States Code or that a drug is a 340B drug including, without limitation, any of the following: a. fees, charges, clawback Free access — add to your briefcase to read the full text and ask questions with AI
A. With respect to reimbursement to a 340B entity for 340B drugs, a health insurance issuer, pharmacy benefits manager, other third-party payor, or its agent shall not: 1. Reimburse a 340B entity for 340B drugs at a rate lower than that paid for the same drug to entities that are not 340B entities or lower reimbursement for a claim on the basis that the claim is for a 340B drug; 2. Impose any terms or conditions on any 340B entity with respect to any of the following that differ from such terms or conditions applied to non-340B entities on the basis that the entity participates in the federal 340B drug discount program set forth in Section 256b of Title 42 of the United States Code or that a drug is a 340B drug including, without limitation, any of the following: a. fees, charges, clawbacks, or other adjustments or assessments. For purposes of this subsection, the term "other adjustments" includes placing any additional requirements, restrictions, or unnecessary burdens upon the 340B entity that result in administrative costs or fees to the 340B entity that are not placed upon other entities that do not participate in the 340B drug discount program, including affiliate pharmacies of the health insurance issuer, pharmacy benefits manager, or other third- party payor, b. dispensing fees that are less than the dispensing fees for non-340B entities, c. restrictions or requirements regarding participation in standard or preferred pharmacy networks, d. requirements relating to the frequency or scope of audits of inventory management systems, e. requirements that a claim for a drug include any identification, billing modifier, attestation, or other indication that a drug is a 340B drug in order to be processed or resubmitted unless it is required by the Centers for Medicare and Medicaid Services or the Oklahoma Health Care Authority for the administration of the Oklahoma Medicaid program, or f. any other restrictions, conditions, practices, or policies that are not imposed on non-340B entities; 3. Require a 340B entity to reverse, resubmit, or clarify a claim after the initial adjudication unless these actions are in the normal course of pharmacy business and not related to 340B drug pricing; 4. Discriminate against a 340B entity in a manner that prevents or interferes with any patient's choice to receive such drugs from the 340B entity, including the administration of such drugs. For purposes of this subsection, it is considered a discriminatory practice that prevents or interferes with a patient's choice to receive drugs at a 340B entity if a health insurance issuer, pharmacy benefits manager, or other third-party payor places any additional requirements, restrictions, or unnecessary burdens upon the 340B entity that results in administrative costs or fees to the 340B entity, including but not limited to, requiring a claim for a drug to include any identification, billing modifier, attestation, or other indication that a drug is a 340B drug in order to be processed or resubmitted unless it is required by the Centers for Medicare and Medicaid Services or the Oklahoma Health Care Authority in administration of the Oklahoma Medicaid program; 5. Include any other provision in a contract between a health insurance issuer, pharmacy benefits manager, or other third-party payor and a 340B entity that discriminates against the 340B entity or prevents or interferes with an individual's choice to receive a prescription drug from a 340B entity, including the administration of the drug, in person or via direct delivery, mail, or other form of shipment, or creation of a restriction or additional charge on a patient who chooses to receive drugs from a 340B entity; 6. Require or compel the submission of ingredient costs or pricing data pertaining to 340B drugs to any health insurance issuer, pharmacy benefits manager, or other third-party payor; or 7. Exclude any 340B entity from the health insurance issuer, pharmacy benefits manager, or other third-party payor network on the basis that the 340B entity dispenses drugs subject to an agreement under Section 256b of Title 42 of the United States Code, or refusing to contract with a 340B entity for reasons other than those that apply equally to non-340B entities. B. Nothing in this section applies to the Oklahoma Medicaid program as payor when Medicaid provides reimbursement for covered outpatient drugs as defined in Section 1396r-8(k) of Title 42 of the United States Code.