A federal appeals court has struck down provisions in a state law authored with the intent of ensuring access to smaller pharmacies. The 10th Circuit U.S. Court of Appeals ruled that the Employee Retirement Income Security Act and Medicare preempt an Oklahoma law regulating pharmacy benefit managers. The Oklahoma Legislature passed the Patient’s Right to Pharmacy Choice Act in 2019, House Bill 2632, to protect access to pharmacy providers and define compliance standards for retail pharmacy networks. The law then was challenged in court by the Pharmaceutical Care Management Association, a lobby for PBMs.

n April 2022, the U.S. District Court for the Western District of Oklahoma ruled favorably for Oklahoma Insurance Commissioner Glen Mulready, upholding a majority of the provisions of the Patient’s Right to Pharmacy Choice Act against a preemption challenge by the PCMA, which subsequently appealed the decision to the 10th Circuit U.S. Court of Appeals, asserting that the four remaining provisions out of 13 are preempted by Medicare Part D and ERISA.

On Tuesday, the federal court released an opinion in PCMA v. Mulready. The court cited CIGNA Healthplan of La., Inc. v. Louisiana and Ky. Ass’n of Health Plans v. Nichols as precedent to support the opinion that network restrictions in the PRPCA functionally “mandate benefit structures.” The ruling essentially asserts the state’s act is an overextension into federal regulation through interference with “nationally uniform plan administration.”

The Oklahoma State Senate and House overrode a veto by Gov. Kevin Stitt (R) of HB 1843, which is legislation to move PBM enforcement authority from the Office of the Insurance Commissioner to the Attorney General. Because the override coincided with Commissioner Glen Mulready’s scheduled hearing with an administrative law judge about his work to censure, suspend, place on probation or revoke the PBM license of CVS Caremark, the hearing has now been postponed until November, when Oklahoma Attorney General Gentner Drummond is expected to take on the matter.

CVS/Caremark, one of the nation’s largest pharmacy benefits managers, has again drawn scrutiny by insurance regulators for allegedly running afoul of state pharmacy choice laws. In a notice of hearing and order to show cause filed Tuesday, Oklahoma Insurance Commissioner Glen Mulready said his office has received more than 100 complaints alleging that CVS denied prescription claims submitted by Oklahoma pharmacies on behalf of customers and told they were required to have their prescriptions filled at CVS pharmacies. The insurance commissioner in February put CVS on notice that it believed it was in violation of state law and CVS responded, it said, with corrective action. But Mulready said the company has since told its large client employers that filing 90-day prescriptions is now prohibited.

Oklahoma entered settlement agreements with three major pharmacy chains and an opioid manufacturer totaling more than $226 million, Attorney General John O’Connor announced recently. Including the new settlements with drugmaker Allergan and pharmacy chains CVS, Walgreens and Walmart, Oklahoma has received more than $900 million from opioid makers and distributors to help address the state’s opioid crisis, O’Connor said. The settlements are the latest in a wave of deals that state and local governments have struck with companies, including drugmakers, distribution companies and even a consulting firm, even as some lawsuits over how the drugs are marketed and sold continue. The total of proposed and finalized settlements is now more than $50 billion.

The Oklahoma Board of Pharmacy has proposed rules that aim to keep mailed medications safe through delivery from extreme temperatures and other inclement weather. The rules are the first of their kind among the states as most state boards of pharmacy do not have specific rules for shipping medications. The new rules would require all pharmacies shipping and delivering medication to use packaging tested to keep drugs within their safe temperature ranges. The rules also require pharmacies to assess the safety of medication that is delayed during delivery and mandate that all patients are notified of shipping and delivery.

A new bill, HB 2322, grants provider status to Oklahoma pharmacists. This bill HB 2322, defines pharmacists as “essential community providers” and mandates that pharmacists get payment parity for healthcare services through the state Medicaid program. Under this mandate, pharmacists will receive direct payment or reimbursement for services rendered at no less than the rate of other providers performing the same services. HB 2322 marks an important step in achieving provider status for all pharmacists in all states.

Oklahoma Governor Kevin Stitt (R) recently signed a new bill, SB 737, into law. SB 737 expands on the state’s patient choice bill, SB 1860, and fights PBMs in a new way. SB 737 gives the insurance commissioner greater enforcement authority over PBMs, prevents spread pricing, and prohibits pharmacy network participation fees. In effect, it ensures that patients and pharmacies alike are safe from abusive PBM practices.

Oklahoma leaders and lawmakers are advocating for greater patient choice with one new bill. This bill, SB 1860, would strengthen existing statutes protecting a patient’s authority to utilize the pharmacy of their choice. It would limit patient steering and restrict PBMs from incentivizing patients to pick one pharmacy over another. SB 1860 marks an important step in fighting for pharmaceutical freedom. It is now being considered in the House of Representatives.

Oklahoma Gov. Stitt signed 3 pro-pharmacy, pro-patient bills into law, while vetoing another that would have given paitents greater authority in selecting in-network pharmacies of their own choice. The 3 successfully passed laws do the following: helps to strengthen fair pharmacy audit laws to hold PBMs accountable, requires insurers to reimburse pharmacies for covered services, and also creates the Patient's Right to Pharmacy Choice Commission.

SB 398 was passed in response to the COVID-19 pandemic, broadening the authority of pharmacists in Oklahoma as it pertains to the administration of vaccines. It authorizes pharmacists to administer any FDA approved or authorized vaccine without a prescription.