OklahomaHB 1808Oklahoma 2026 Regular SessionHouse

Health insurance; creating the Ensuring Transparency in Prescription Drugs Prior Authorization Act; determination; consultation; prior authorization; effective date.

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Bill Overview

Analyzed Economic Effects

5 provisions identified: 5 benefits, 0 costs, 0 mixed.

Faster drug approval decisions for patients

Beginning November 1, 2025, the law's drug approval protections cover commercial health plans and the Oklahoma Medicaid State Plan. Review entities must decide and notify patients and providers within 24 hours for urgent requests, or four business days otherwise. These deadlines start after all needed information arrives, including required in-person exams or second opinions. A drug is automatically approved if the deadline is missed after the provider submits all needed information through the authorized system. Approval notices to providers must state the approval's length or expiration date, and drugs given during emergency care do not require prior approval.

Longer drug approvals protect patient coverage

Beginning November 1, 2025, approved drugs for chronic conditions keep approval for three years while patients stay on the same plan. Exceptions apply when clinical criteria change, a generic is removed, or the drug moves to a less-preferred tier; opioids and weight-loss drugs are excluded. After patients or providers document an existing approval, a new plan must honor it for at least its first 60 days. The same protection applies for 60 days after switching products within one insurer, unless the new product does not cover the service. Plans may review approvals during either transition, and these transition rules apply only when consistent with law, regulations, and the Oklahoma Medicaid State Plan.

Clearer drug coverage information for patients

Beginning November 1, 2025, plans must post current covered-drug lists, and review entities must post understandable approval rules, restrictions, and clinical criteria. Before changing approval rules, entities must update their websites and give at least 60 days' notice to qualified contracted prescribers or chronic-condition patients already taking the drug. That notice rule applies only when consistent with law, regulations, and the Oklahoma Medicaid State Plan; entities also must help with notices about coverage-list and approval-rule changes. Plans must submit secure links to their covered-drug lists to the Insurance Commissioner by October 1 each year, removing confidential or trade-secret information. The Commissioner must set standard reporting rules and publish insurer reports by December 31, 2025, and each December 31 afterward.

Fairer drug denial reviews for patients

Beginning November 1, 2025, drug denial or reduction notices must clearly inform patients and identify covered alternative drugs. Decisions require a qualified doctor, pharmacist, or licensed mental health professional with a current, unrestricted U.S. license and relevant expertise. Reviewers work under the responsible drug-use committee or board's clinical direction, and medical directors must be U.S.-licensed doctors. Appeal reviewers must have no prior involvement in the denial or financial stake in the outcome, and must hold unrestricted U.S. licenses. They generally must have the same or a similar specialty, with exceptions for pharmacists and mental health professionals, and consider relevant clinical facts, records, and medical literature supplied by providers.

State fines enforce patient drug protections

Beginning November 1, 2025, the Insurance Commissioner can fine a person or organization up to $5,000 per violation. The Attorney General can fine a pharmacy benefits manager up to $5,000 per violation. Each penalty requires notice, a chance for an administrative hearing, and a written order stating the findings. These fines can apply alongside other legal penalties, and Oklahoma Medicaid is also subject to penalties for violating the act.

Sponsors & Cosponsors

Sponsor

Carl Newton
Republican • House

Cosponsors

Arturo Alonso Sandoval
Democratic • House
Jared Deck
Democratic • House
Eddy Dempsey
Republican • House
Mark Lawson
Republican • House
Annie Menz
Democratic • House
Nicole Miller
Republican • House
Cyndi Munson
Democratic • House
Daniel Pae
Republican • House
Dave Rader
Republican • Senate
Brenda Stanley
Republican • Senate

Roll Call Votes

All Roll Calls

Yes: 303 • No: 17

Senate vote • 5/22/2025

FOURTH READING

Yes: 42 • No: 0

House vote • 5/22/2025

FOURTH READING

Yes: 80 • No: 7

Senate vote • 5/8/2025

THIRD READING

Yes: 42 • No: 1

Senate vote • 4/23/2025

Committee vote: Appropriations

Yes: 21 • No: 2

Senate vote • 4/10/2025

Committee vote: Business & Insurance

Yes: 9 • No: 0

House vote • 3/24/2025

THIRD READING

Yes: 88 • No: 7

House vote • 3/6/2025

DO PASS

Yes: 14 • No: 0

House vote • 2/24/2025