ORS 735.530
Definitions for ORS 735.530 to 735.552


As used in ORS 735.530 (Definitions for ORS 735.530 to 735.552) to 735.552 (Pharmacy claims audits):

(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)

“Enrollee” means an individual who has enrolled for coverage in a health benefit plan for which a pharmacy benefit manager has contracted with the insurer to reimburse claims submitted by pharmacies or pharmacists for the costs of drugs prescribed for the individual.

(3)

“Health benefit plan” has the meaning given that term in ORS 743B.005 (Definitions).

(4)

“Insurer” has the meaning given that term in ORS 731.106 (“Insurer.”).

(5)

“Long term care pharmacy” means a pharmacy for which the primary business is to serve a:

(a)

Licensed long term care facility, as defined in ORS 442.015 (Definitions);

(b)

Licensed residential facility, as defined in ORS 443.400 (Definitions for ORS 443.400 to 443.455); or

(c)

Licensed adult foster home, as defined in ORS 443.705 (Definitions for ORS 443.705 to 443.825).

(6)

“Mail order pharmacy” means a pharmacy for which the primary business is to receive prescriptions by mail, telephone or electronic transmission and dispense drugs to patients through the use of the United States Postal Service, a package delivery service or home delivery.

(7)

“Network pharmacy” means a pharmacy that contracts with a pharmacy benefit manager.

(8)

“Pharmacist” has the meaning given that term in ORS 689.005 (Definitions).

(9)

“Pharmacy” includes:

(a)

A pharmacy as defined in ORS 689.005 (Definitions);

(b)

A long term care pharmacy; and

(c)

An entity that provides or oversees administrative services for two or more pharmacies.

(10)

“Pharmacy benefit” means the payment for or reimbursement of an enrollee’s cost for prescription drugs.

(11)

Intentionally left blank —Ed.

(a)

“Pharmacy benefit manager” means a person that contracts with pharmacies on behalf of an insurer offering a health benefit plan, 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).

(12)

“Specialty drug” means a drug that:

(a)

Is subject to restricted distribution by the United States Food and Drug Administration; or

(b)

Requires special handling, provider coordination or patient education that cannot be provided by a retail pharmacy.

(13)

“Specialty pharmacy” means a pharmacy capable of meeting the requirements applicable to specialty drugs.

(14)

“Third party administrator” means a person licensed under ORS 744.702 (Third party administrator license).

(15)

“340B pharmacy” means a pharmacy that is authorized to purchase drugs at a discount under 42 U.S.C. 256b. [2013 c.570 §2; 2017 c.73 §5; 2019 c.526 §3]
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.

Source: Section 735.530 — Definitions for ORS 735.530 to 735.552, https://www.­oregonlegislature.­gov/bills_laws/ors/ors735.­html.

735.005
Definitions for ORS 735.005 to 735.145
735.015
Purpose
735.025
Construction
735.035
Application
735.045
Oregon FAIR Plan Association
735.055
Association board of directors
735.065
Required association functions
735.075
Discretionary association functions
735.085
Plan of operation
735.095
Contents of plan of operation
735.105
Regulation of association as insurer
735.115
Exemption of association from fees and taxes
735.145
Immunity from legal action in carrying out duties
735.150
Definitions for ORS 735.150 to 735.190
735.152
Application of laws
735.154
Rules
735.156
Confidentiality of documents and materials
735.158
Certificate of authority
735.160
Business name
735.162
Capital and surplus requirements
735.164
Incorporation of pure captive insurer and association captive insurer
735.166
Investment requirements for association captive insurer
735.168
Allowable risks for captive insurer
735.170
Rating organization
735.172
Reporting
735.174
Examination
735.176
Compliance with sound actuarial principles
735.178
Suspension or revocation of certificate of authority
735.180
Branch captive insurer as pure captive insurer
735.182
Examination of branch captive insurer and alien captive insurer
735.184
Requirements for foreign captive insurer to provide insurance in this state
735.186
Management of assets of captive reinsurer
735.188
Application of captive reinsurer for certificate of authority
735.190
Incorporation of captive reinsurer
735.200
Legislative findings
735.205
Definitions for ORS 735.200 to 735.260
735.210
Formation of market assistance plans
735.215
Findings prior to formation of joint underwriting association
735.220
Formation of joint underwriting association
735.225
Membership in joint underwriting association
735.230
Rates
735.235
Board of directors
735.240
Annual statement
735.245
Conditions for policyholder surcharge
735.250
Exemption from liability
735.255
State not liable to pay debts of association
735.260
Rules
735.265
Liquor liability insurance risk and rate classifications
735.300
Purpose of ORS 735.300 to 735.365
735.305
Definitions for ORS 735.300 to 735.365
735.310
Qualifications for risk retention group
735.315
Foreign risk retention groups
735.320
Relationship to insurance guaranty fund and joint underwriting association
735.325
Exemption of purchasing groups from certain laws
735.330
Purchasing groups
735.335
Purchase of insurance by purchasing group
735.340
Insurance Code enforcement authority subject to federal law
735.345
Violation of 735.300 to 735.365
735.350
Agent or broker
735.355
Court orders enforceable in Oregon
735.360
Rules
735.365
Short title
735.400
Purposes of ORS 735.400 to 735.495
735.405
Definitions for ORS 735.400 to 735.495
735.406
Cost of living adjustment to net worth, revenues and expenses of exempt commercial purchasers
735.410
Conditions for procuring insurance through nonadmitted insurer
735.415
Qualifications for placement of coverage with nonadmitted insurer
735.417
Insured required to report and pay taxes on independently procured insurance covering Oregon home state risks
735.418
Director authorized to enter into interstate compact for premium tax allocation
735.420
Declaration of ineligibility of surplus lines insurer
735.425
Filing by licensee after placement of surplus lines insurance
735.430
Surplus Line Association of Oregon
735.435
Evidence of insurance
735.440
Validity of contracts
735.445
Effect of payment of premium to surplus lines licensee
735.450
Requirements for license as surplus lines insurance licensee
735.455
Authority of licensee
735.460
Records of licensee
735.465
Monthly reports
735.470
Premium tax
735.475
Suit to recover unpaid tax
735.480
Suspension or revocation of license
735.485
Actions against surplus lines insurer
735.490
Jurisdiction in action against insurer
735.492
Application of certain Insurance Code provisions to surplus lines insurers
735.495
Short title
735.500
Requirements for certification as retainer medical practice
735.510
Notice to department of specified changes to practice
735.515
Charges for services not covered by contract
735.520
Oregon Essential Workforce Health Care Program
735.530
Definitions for ORS 735.530 to 735.552
735.532
Registration of pharmacy benefit managers
735.533
Denial, suspension or revocation of registration as pharmacy benefit manager
735.534
Claim reimbursement
735.536
Requirements for pharmacy benefit manager’s reimbursement for cost of drugs
735.540
Definitions for ORS 735.540 to 735.552
735.542
Pharmacy claims audits
735.544
Pharmacy claims audits
735.546
Pharmacy claims audits
735.548
Pharmacy claims audits
735.550
Pharmacy claims audits
735.552
Pharmacy claims audits
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