ORS 735.530¹
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)(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: The amendments to 735.530 (Definitions for ORS 735.530 to 735.552) by section 3, chapter 526, Oregon Laws 2019, apply to pharmacy benefits and to contracts entered into, renewed or extended on or after January 1, 2021. See section 5, chapter 526, Oregon Laws 2019. The text that is applicable until January 1, 2021, is set forth for the user’s convenience.

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) “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).

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.

1 Legislative Counsel Committee, CHAPTER 735—Alternative Insurance, https://­www.­oregonlegislature.­gov/­bills_laws/­ors/­ors735.­html (2019) (last ac­cessed May 16, 2020).
 
2 OregonLaws.org contains the con­tents of Volume 21 of the ORS, inserted along­side the per­tin­ent statutes. See the preface to the ORS An­no­ta­tions for more information.
 
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. Currency Information