MedicaidAdministrativeMedium impact
Provider Letter 2025-05: RE: SoonerSelect Cumulative Refill Too Soon Threshold for Oklahoma Complete Health and Oklahoma Complete Health Children’s Specialty Program
Oklahoma SoonerCare·OK·Pharmacy
Effective date
Feb 1, 2025
We identified it
Jun 20, 2026
Summary
Oklahoma Complete Health and Oklahoma Complete Health Children's Specialty Program have implemented new pharmacy refill threshold policies. In addition to the existing 80% refill threshold, they now use a 90% cumulative refill too soon threshold with 100-day claims history look-back for all medications except transplant drugs and ophthalmic drops.
Action Required
No immediate billing system changes required. Pharmacy staff should be aware that Oklahoma Complete Health members may experience different refill approval patterns due to the new 90% threshold policy. Monitor for any pharmacy-related prior authorization requests that may result from the stricter refill controls.