Oklahoma HB1808: Health insurance; creating the Ensuring Transparency in Prescription Drugs Prior Authorization Act; determination; consultation; prior authorization; effective date.

What the bill says

An Act relating to health insurance; creating the Ensuring Transparency in Prescription Drugs Prior Authorization Act; defining terms; requiring disclosure and review of prior authorization for prescription drugs; requiring certain personnel make adverse determinations; requiring consultation prior to adverse determination; requiring certain criteria for reviewing physicians; providing an exception for prior authorization; prohibiting certain retrospective denial; providing for length of prior authorization; providing for length of prior authorization in special circumstances…

From the enrolled text, May 22, 2025:

An Act relating to health insurance; creating the Ensuring Transparency in Prescription Drugs Prior Authorization Act; defining terms; requiring disclosure and review of prior authorization for prescription drugs; requiring certain personnel make adverse determinations; requiring consultation prior to adverse determination; requiring certain criteria for reviewing physicians; providing an exception for prior authorization; prohibiting certain retrospective denial; providing for length of prior authorization; providing for length of prior authorization in special circumstances; providing continuity of care; providing standard for transmission of authorization; providing for failure to comply; providing for noncodification; providing for codification; and providing an effective date. SUBJECT: Health insurance SECTION 1. NEW LAW A new section of law not to be codified in the Oklahoma Statutes reads as follows: This act shall be known and may be cited as the "Ensuring Transparency in Prescription Drugs Prior Authorization Act". SECTION 2. NEW LAW A new section of law to be codified in the Oklahoma Statutes as Section 6570.50 of Title 36, unless there is created a duplication in numbering, reads as follows: As used in this act: 1. "Adverse determination" means a determination by a health carrier, pharmacy benefits manager (PBM), or its designee utilization review entity that a prescription drug that is a covered benefit has been reviewed and, based upon the information provided, does not meet the health …

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