Senate Bill 1337 which includes provisions outlining Managed Medicaid in the State was heard on the Senate floor on 05/19/2022 and passed 34-10, before crossing to the House on 05/20/2022 and passing 70-16.
Since a complete carve out was not an option, OPhA worked to establish a “rate floor” that would not allow an outside PBM to pay an Oklahoma pharmacy less than the current fee-for-service SoonerCare system does. OPhA also requested that the end date for the guaranteed rate schedule that existed in the bill be removed for pharmacy. Those two pieces were included in Senate Bill 1337.
OPhA worked with legislative leaders to ensure that pharmacists be included in the list of “Essential Community Providers” to ensure that the provisions that applied to other healthcare professionals would apply to pharmacies as well. While on the topic, OPhA mentioned that pharmacies are already performing clinical services for SoonerCare patients and that we should be getting paid for those services. OPhA was able to draft language that would guarantee payment to pharmacies for services rendered to Medicaid members. The specifics of the services are still in the works. OPhA will likely look at a Clinical Service Work Group in the future to further investigate what can be done with this new opportunity. These topics had to be entered into a “trailer bill”, House Bill 2322 by McEntire and Taylor. House Bill 2322 passed the House 80-0 on 05/19/2022 and passed the Senate 41-3 on 05/20/2022.
Both bills were sent to the Governor on 05/20/2022.
From the beginning, OPhA has requested a carve-out but was told that this was not possible. With Managed Medicaid being brought up session after session and considering Governor’s stance on the subject, we know that it will eventually happen. The decision to fight for the rate floor, remove the rate schedule end date, and include pharmacy as an Essential Community Provider was about managing risks and looking to the future.
OPhA would like to thank our bill authors Representative Marcus McEntire, Senate Floor Leader Greg McCortney, Senator Taylor as well as Representative TJ Marti, Senator Rob Standridge, and House Speaker McCall for their efforts, insight, and hard work this session. Thank you to everyone who has been involved and provided feedback. The Association is always looking for engaged members to help shape the future of pharmacy in Oklahoma.