2016 Oklahoma Statutes
Title 36. Insurance
§36-3634.4. Prescription drug or device coverage – Uniform prescription drug information on card or technology.

A. 1. It is the intent of the Legislature to:

a.lessen waiting times of patients,

b.decrease administrative burdens for pharmacies, and

c.improve care to patients,

by minimizing confusion, eliminating unnecessary paperwork and streamlining dispensing of prescription products paid for by third-party payors.

2. This section shall be broadly applied and interpreted to effectuate this purpose.

B. 1. Each health benefit plan that provides coverage for prescription drugs or devices, or administers such a plan including, but not limited to, third-party administrators for self-insured plans, to the extent permitted by the Employee Retirement Income Security Act of 1974 (ERISA), and state-administered plans, or the plan’s agents or contractors that issue a card or other technology for prescription claims submission and adjudication, shall issue to its insureds covered by such plan a card or other technology containing uniform prescription drug information. Nothing in this section shall require any health benefit plan, or the plan’s agents or contractors to issue a separate card of other technology for prescription coverage, provided that the card issued can accommodate the information required by this section.

2. The uniform prescription drug information contained on the insured’s card or other technology shall include the following fields:

a.card issuer name or logo on the front of the card,

b.complete information for electronic claims routing including:

(1)issuer identification number (IIN/BIN) labeled as IIN or BIN,

(2)the Processor Control Number (PCN), labeled as PCN, if required for proper routing of electronic claim transactions for prescription benefits, and

(3)the group number, labeled as GRP, if required for proper routing of electronic claim transactions for prescription benefits,

c.card issuer identification,

d.card holder identification, which shall be displayed on the front of the card,

e.card holder name, which shall be displayed on the front of the card,

f.claims processor name and, if not filed electronically, address, and

g.a help desk phone number that pharmacy providers may call for pharmacy benefit claims assistance.

C. 1. The new uniform prescription drug information contained on the insured’s card or other technology, as required by subsection B of this section, shall be issued by a health benefit plan or the plan’s administrators, agents or contractors upon enrollment, and reissued within a reasonable time upon any change in the coverage of the insured person that impacts data contained on the card.

2. Newly issued cards or technology shall be updated with the latest coverage information.

D. As used in this section, "health benefit plan" means an accident and health insurance policy or certificate, a nonprofit hospital or medical service corporation contract, a health maintenance organization subscriber contract, a plan provided by a multiple employer welfare arrangement, or a plan provided by another benefit arrangement, to the extent permitted by ERISA of 1974, as amended, or by any waiver of or other exception to that act provided under federal law or regulation. The term "health benefit plan" shall not include the following types of insurance:

1. Accident;

2. Credit;

3. Disability income;

4. Long-term or nursing home care;

5. Specified disease;

6. Dental or vision;

7. Coverage issued as a supplement to liability insurance;

8. Medical payments under automobile or homeowners;

9. Insurance under which benefits are payable with or without regard to fault and this is statutorily required to be contained in any liability policy or equivalent self-insurance;

10. Health benefit plans that participate or contract with the Oklahoma Health Care Authority as the state Medicaid agency; and

11. Hospital income or indemnity.

E. The provisions of this section shall apply to health benefit plans that are delivered, issued for delivery, or renewed on and after January 1, 2004.

F. 1. Enforcement of the provisions of this section shall be the responsibility of the Insurance Commissioner.

2. The Insurance Commissioner shall promulgate rules necessary to effectuate the provisions of this section.

3. The Insurance Commissioner shall take action or impose appropriate penalties to bring noncomplying entities into full compliance with the provisions of this section.

Added by Laws 2002, c. 409, § 2, eff. Nov. 1, 2003.