§36-6965. Power and authority to investigate, examine, and enforce.
662 words·~3 min read·
/ok/title-36-insurance/36-6965·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
A. The Attorney General shall have power and authority to examine and investigate the affairs of every pharmacy benefits manager
(PBM)engaged in pharmacy benefits management in this state in order to determine whether such entity is in compliance with the Patient’s Right to Pharmacy Choice Act, the Pharmacy Audit Integrity Act, and Sections 357 through 360 of Title 59 of the Oklahoma Statutes.
B. The Attorney General shall have the power and authority to subpoena witnesses and records, whether prior to or during an investigation or prosecution of a complaint, from any relevant entity or persons to ensure compliance with the Patient’s Right to Pharmacy Choice Act, the Pharmacy Audit Integrity Act, and Sections 357 through 360 of Title 59 of the Oklahoma Statutes.
C. All PBM files and records shall be subject to examination by the Attorney General or by duly appointed designees. The Attorney General, authorized employees and examiners shall have access to any of a PBM’s files and records that may relate to a particular complaint under investigation or to an inquiry or examination by the Attorney General.
D. Every officer, director, employee or agent of the PBM, upon receipt of any inquiry from the Attorney General, shall, within twenty
(20)days from the date the inquiry is sent, furnish the Attorney General with an adequate response to the inquiry.
E. When making an examination under this section, the Attorney General may retain subject matter experts, attorneys, appraisers, independent actuaries, independent certified public accountants or an accounting firm or individual holding a permit to practice public accounting, certified financial examiners or other professionals and specialists as examiners, the cost of which shall be borne by the PBM that is the subject of the examination.
F. 1. Protected health information
(PHI)held by a PBM shall be provided at the request of the Attorney General for the purpose of conducting investigations into potential violations of state laws and regulations related to the PBM. Disclosure of protected health information shall be limited to the extent necessary for the investigation and enforcement of state law.
2. All disclosures of protected health information shall be made in compliance with all applicable federal and state privacy laws, including the Health Insurance Portability and Accountability Act of 1996 (HIPAA), and other relevant laws protecting the privacy and confidentiality of health information.
3. Any protected health information obtained for an investigation shall be handled and maintained per applicable federal and state privacy laws and regulations, including HIPAA.
4. Unauthorized disclosure of protected health information obtained during an investigation is strictly prohibited and subject to legal penalties.
G. 1. If the Attorney General, after notice and opportunity for hearing, finds that any PBM operating within this state has not fully cooperated with an investigation or inquiry conducted by the Attorney General related to compliance with the Patient’s Right to Pharmacy Choice Act, the Pharmacy Audit Integrity Act, and Sections 357 through 360 of Title 59 of the Oklahoma Statutes, the Attorney General may instruct the Insurance Commissioner that the PBM be censured or his or her license be suspended or revoked. If the Attorney General makes such instruction, the Commissioner shall enforce the instructed action within thirty
(30)days.
2. In addition to or in lieu of any censure, suspension, or revocation by the Commissioner, the Attorney General may levy a civil or administrative fine not less than One Hundred Dollars ($100.00) and not greater than Ten Thousand Dollars ($10,000.00) for each violation of this subsection and assess any other penalty or remedy authorized by this act. For purposes of this section, each day a PBM fails to comply with an investigation or inquiry may be considered a separate violation. Added by Laws 2019, c. 426, § 8, eff. Nov. 1, 2019. Amended by Laws 2021, c. 472, § 9, emerg. eff. May 11, 2021; Laws 2023, c. 293, § 2, eff. Nov. 1, 2023; Laws 2024, c. 306, § 3, emerg. eff. May 15, 2024.