Senate committee advances bill to set PBM reimbursement floor and require Medicaid-based dispensing fee

The Oklahoma Senate Business and Insurance Committee on Monday approved Senate Bill 2074, a measure that would set a reimbursement floor for pharmacy benefit managers (PBMs) using the Oklahoma Medicaid methodology and establish a professional dispensing fee no less than the state Medicaid rate. The committee approved the bill on a 10-0 roll call.

Vice Chair Alford, who presented the bill to the committee, said the measure is intended to "protect Oklahomans access to their local pharmacies by ensuring fair and transparent reimbursement using the same methodology that is already used in the Oklahoma Medicaid program." He told members the approach is familiar and has been adopted by other states: "Oklahoma would join at least 14 states that have adopted a reimbursement floor and about a dozen that require a professional dispensing fee."

Why it matters: supporters argued PBM vertical integration and reimbursement practices have strained independent and rural pharmacies. Alford cited national figures and audits, saying states that adopted similar protections saw mitigations in premium increases and patient cost sharing. "We have had over 800 pharmacies close nationwide," he said, adding that several local pharmacies have closed in the past years.

What the bill would do: the measure would require PBM reimbursement calculations to follow the Oklahoma Medicaid methodology and institute a professional dispensing fee equal to or greater than the state Medicaid fee. In committee discussion, Alford described recent testimony showing a private-sector average dispensing fee of about $0.98 and said Oklahoma Medicaid's fee for service is "approximately $10." He said the intent is that the fee not be shouldered by consumers: "My desire in incurring this bill was always and still is that this cost not go to the consumer and not go to the plan."

Questions and legal concerns: senators asked whether the fee might be passed through to patients or plans and whether the statute could legally single out specific businesses. Senator Brooks asked, "Is there anything in the bill to be able to indicate that this isn't gonna be assessed to the consumer, that it's not gonna be paid at the counter?" Alford responded that the bill's goal is to avoid shifting costs to patients but acknowledged the PBM and parent insurance companies ultimately choose how fees are allocated. He also said staff and the Attorney General's office are advising on legal language to avoid unlawful restraints on trade.

Support and debate: multiple committee members spoke in support, describing the issue as both a small-business and rural-access problem. Senators described the system as "complicated" but urged action to preserve community pharmacies. Alford urged members to review outside analyses and presentations about PBMs to better understand the industry structure.

Next steps: the committee passed the bill unanimously and sent it forward; members were told the session will reconvene next week to take up remaining bills.

The committee record shows a roll-call tally of 10 ayes and 0 nays on Senate Bill 2074.