Oklahoma Senate Bill 789 is a significant legislative proposal that aims to further reform regulations governing Pharmacy Benefit Managers (PBMs) in the state.

The bill includes key provisions such as prohibiting PBMs from leasing, renting, or sharing their provider networks with other PBMs, bans effective rate contracting between PBMs and pharmacies, and proposes the adoption of a floor on pharmacy reimbursement, at NADAC plus 6% and includes a $15 minimum dispense fee, subject to annual adjustment based on the Consumer Price Index.

The proposed minimum dispense fee is three times the current workers' comp fee schedule maximum dispense fee. These changes are intended to increase transparency and fairness in the pharmaceutical reimbursement process; however they have the potential to create complexity, limit competition, and impede access to care within the workers’ comp system.

The potential risks associated with Senate Bill 789 could impact claim costs and injured workers' access to care. By eliminating effective rate contracts, the bill may lead to unpredictable drug pricing and higher pharmacy reimbursement rates, making it more challenging for PBMs and payers to accurately forecast overall drug costs. This could result in increased costs for employers, insurers, and public entities funding workers' compensation claims. The bill was last heard in committee on February 20, and if enacted would become effective in November 2025.

As the bill progresses through the legislative process, stakeholders will need to carefully consider these potential impacts to ensure that the needs of injured workers and the overall workers’ comp system are adequately addressed. Healthesystems is engaging with interested stakeholders and legislators to ensure the impacts to workers’ comp payers, PBMs and injured worker community are considered in order to avoid unnecessary disruption to the care of injured workers.