Pharmacy benefit manager to manage prescription drug benefits
(1) Subject to the provisions of subsection (4) of this section, the Department of Human Services shall contract with a pharmacy benefit manager to manage prescription drug benefits for the medical assistance program. The pharmacy benefit manager shall purchase prescription drugs in bulk or reimburse pharmacies for prescription drugs prescribed for eligible persons in the medical assistance program.
(2) The pharmacy benefit manager shall establish two programs for the medical assistance program. One program shall purchase prescription drugs for or reimburse fully capitated health plans that use the pharmacy benefit manager under contract with the department. The second program shall reimburse fee-for-service pharmacy providers directly or provide for payment by the Department of Human Services.
(3) Fully capitated health plans may use the pharmacy benefit manager under contract with the department under subsection (1) of this section.
(4) In awarding a contract under this section, the department must ensure that the contractor has the capacity and competence to administer the services and that the contract is cost-neutral to the department.
(5) ORS 414.325 (Prescription drugs) and 414.334 (Practitioner-Managed Prescription Drug Plan for Oregon Health Plan) apply to the management of prescription drug benefits under this section. [2003 c.810 §13]
Note: 414.744 (Pharmacy benefit manager to manage prescription drug benefits) becomes operative the day after the date the Department of Human Services receives the necessary waivers from the Centers for Medicare and Medicaid Services. See section 18, chapter 810, Oregon Laws 2003.
Note: See note under 414.736 (Definitions).
3 OregonLaws.org assembles these lists by analyzing references between Sections. Each listed item refers back to the current Section in its own text. The result reveals relationships in the code that may not have otherwise been apparent.