Bill > HB1808

This bill creates the Ensuring Transparency in Prescription Drugs Prior Authorization Act, which establishes new regulations for how health insurance companies and pharmacy benefits managers (PBMs) handle prescription drug prior authorizations. The bill requires utilization review entities to make their prior authorization requirements and clinical criteria publicly accessible on websites, provide at least 60 days' notice before implementing new requirements, and ensure that adverse determinations are made by qualified physicians, pharmacists, or licensed mental health professionals. For chronic condition medications, prior authorizations will remain valid for three years if the patient stays on the same health plan. The bill mandates specific timelines for prior authorization decisions (24 hours for urgent prescriptions, 4 business days for non-urgent), prohibits prior authorization for emergency health services, and provides continuity of care provisions when patients change health plans or insurance products. Additionally, the bill establishes penalties of up to $5,000 for violations, which can be imposed by the Insurance Commissioner or the Attorney General, and will apply to the Oklahoma Medicaid State Plan, becoming effective on November 1, 2025.

Budget and Finance, Business and Industry

http://www.oklegislature.gov/BillInfo.aspx?Bill=hb1808&Session=2500