ORS 735.536
Requirements for pharmacy benefit manager’s reimbursement for cost of drugs

  • rules

(1)

As used in this section, “out-of-pocket cost” means the amount paid by an enrollee under the enrollee’s coverage, including deductibles, copayments, coinsurance or other expenses as prescribed by the Department of Consumer and Business Services by rule.

(2)

A pharmacy benefit manager registered under ORS 735.532 (Registration of pharmacy benefit managers):

(a)

May not require a prescription to be filled or refilled by a mail order pharmacy as a condition for reimbursing the cost of the drug.

(b)

Except as provided in paragraph (c) of this subsection, may require a prescription for a specialty drug to be filled or refilled at a specialty pharmacy as a condition for the reimbursement of the cost of a drug.

(c)

Shall reimburse the cost of a specialty drug that is filled or refilled at a network pharmacy that is a long term care pharmacy.

(d)

Intentionally left blank —Ed.

(A)

Shall allow a network pharmacy to mail, ship or deliver prescription drugs to its patients as an ancillary service.

(B)

Is not required to reimburse a delivery fee charged by a pharmacy for a delivery described in subparagraph (A) of this paragraph unless the fee is specified in the contract between the pharmacy benefit manager and the pharmacy.

(e)

May not require a patient signature as proof of delivery of a mailed or shipped prescription drug if the network pharmacy:

(A)

Intentionally left blank —Ed.
(i)
Maintains a mailing or shipping log signed by a representative of the pharmacy; or
(ii)
Maintains each notification of delivery provided by the United States Postal Service or a package delivery service; and

(B)

Is responsible for the cost of mailing, shipping or delivering a replacement for a drug that was mailed or shipped but not received by the enrollee.

(f)

May not penalize a network pharmacy for or otherwise directly or indirectly prevent a network pharmacy from informing an enrollee of the difference between the out-of-pocket cost to the enrollee to purchase a prescription drug using the enrollee’s pharmacy benefit and the pharmacy’s usual and customary charge for the prescription drug.

(3)

The Department of Consumer and Business Services may adopt rules to carry out the provisions of this section. [2019 c.526 §2]
Note: 735.536 (Requirements for pharmacy benefit manager’s reimbursement for cost of drugs) applies 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.
Note: See note under 735.530 (Definitions for ORS 735.530 to 735.552).

Source: Section 735.536 — Requirements for pharmacy benefit manager’s reimbursement for cost of drugs; rules, 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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