OKLAHOMA CITY (OBV) — A Senate bill up for consideration this week has raised alarms among employer groups.
SB 2074 would require pharmacy benefit managers to reimburse pharmacies at the National Average Drug Acquisition Cost (NADAC) and require a professional dispensing fee paid to pharmacists equal to Oklahoma’s Medicaid rate (currently $11.41 under the State Plan), while tightening appeal timelines and documentation.
Employer advocates say a mandated reimbursement rate and required dispensing fee would flow through to plan participants.
“A number of Oklahoma employers have raised concerns about this measure and the impact a state mandatory fee would have on employer‑sponsored health plans,” said Emily Crouch, senior vice president of government affairs at the State Chamber of Commerce. “With costs already rising across the economy, it is concerning to see proposals that add to what Oklahomans pay for everyday prescriptions.”
The Senate fiscal summary using Oklahoma Health Care Authority data estimates a net $11.65 million FY 2027 cost to the state’s EGID/HealthChoice plan if SB 2074’s NADAC payments and Medicaid‑level dispensing fee take effect—driven chiefly by raising the average dispensing fee from about 20¢ to $11.41 per prescription, partly offset by switching to NADAC.
The bill comes on the heels of HB 3538, which passed the House 93–2 and now also adds a per‑prescription dispensing fee tied to the Medicaid rate, on top of its PBM licensing and regulatory additions.
The debate lands in a deadline week, with lawmakers racing to clear bills before the floor cutoff on Thursday.
A similar Mississippi bill sought to set a similar reimbursement rate plus a flat $11.29 dispensing fee per prescription. The White House intervened on the matter of the Mississippi bill and has urged lawmakers to reject it on the grounds that the Senate‑amended version could complicate the President’s policy of providing access to the lowest prices on prescription medications for every American, while threatening access to discounts.
“We … encourage the Mississippi House not to concur with HB 1665 as amended by the Senate and instead remove provisions that risk undermining key administration priorities, particularly those related to expanding access to affordable prescription medications through the TrumpRx.gov initiative,” reads the letter.
What’s next
Senators will decide whether to adopt SB 2074’s Medicaid-anchored fee and expanded appeal requirements. If approved, the bill would move to the House for consideration. The House measure, HB 3538, moves over to the Senate for consideration.
What SB 2074 would do
- New reimbursement rates and increased dispensing fees. PBMs would be required to reimburse pharmacies at the National Average Drug Acquisition Cost (NADAC) and consumers must pay a professional dispensing fee no lower than the state’s Medicaid fee-for-service rate.
- Tightened regulations on PBM practices. PBMs must accept added documentation and answer appeals within 10 days. If the exact drug they referenced isn’t available for the pharmacy to buy at a lower price than the PBM is paying, the PBM has to raise the payment, let the pharmacy reprocess the claim, and apply the increase to similar claims with itemized details.
- Access and licensing guardrails. During FDA-listed shortages, pharmacies must be reimbursed at least Wholesale Acquisition Cost for the specific NDC. Additionally, PBMs cannot require accreditation beyond state or federal licensing requirements. Pharmacies may decline service if they are to be paid less than cost.
- Effective date. Nov. 1, 2026.
