Definitions for ORS 735.530 to 735.552
(1) “Claim” means a request from a pharmacy or pharmacist to be reimbursed for the cost of filling or refilling a prescription for a drug or for providing a medical supply or service.
(2) “Insurer” has the meaning given that term in ORS 731.106 (“Insurer”).
(3) “Pharmacist” has the meaning given that term in ORS 689.005 (Definitions).
(4) “Pharmacy” includes:
(a) A pharmacy as defined in ORS 689.005 (Definitions); and
(b) An entity that provides or oversees administrative services for two or more pharmacies.
(5)(a) “Pharmacy benefit manager” means a person that contracts with pharmacies on behalf of an insurer, a third party administrator or the Oregon Prescription Drug Program established in ORS 414.312 (Oregon Prescription Drug Program) to:
(A) Process claims for prescription drugs or medical supplies or provide retail network management for pharmacies or pharmacists;
(B) Pay pharmacies or pharmacists for prescription drugs or medical supplies; or
(C) Negotiate rebates with manufacturers for drugs paid for or procured as described in this paragraph.
(b) “Pharmacy benefit manager” does not include a health care service contractor as defined in ORS 750.005 (Definitions).
(6) “Third party administrator” means a person licensed under ORS 744.702 (Third party administrator license). [2013 c.570 §2; 2017 c.73 §5]
Note: 735.530 (Definitions for ORS 735.530 to 735.552) to 735.552 (Pharmacy claims audits) were added to and made a part of the Insurance Code by legislative action but were not added to ORS chapter 735 or any series therein. See Preface to Oregon Revised Statutes for further explanation.
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.