This text of Oregon § 743A.062 (Prescription drugs) is published on Counsel Stack Legal Research, covering Oregon primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.
(1)As used in this section:
(a)“Conflict of interest” means:
(A)Present employment, ownership or control by a covered entity, pharmaceutical manufacturer, pharmacy benefit manager or health benefit plan as defined in ORS 743B.005; or (B)Third party employment, ownership or control by a covered entity, pharmaceutical manufacturer, pharmacy benefit manager or health benefit plan as defined in ORS 743B.005. (b)“Covered entity” means a covered entity as defined in 42 U.S.C. 256b(a)(4)(A) and (C) to (G). (c)“Medical assistance program” means the state program that provides medical assistance as defined in ORS 414.025. (d)“340B drug” means a covered drug dispensed by a covered entity, as those terms are defined in 42 U.S.C. 256b, that is subject to the cap on amounts required to be paid i Free access — add to your briefcase to read the full text and ask questions with AI
(1) As used in this section:
(a) “Conflict of interest” means:
(A) Present employment, ownership or control by a covered entity, pharmaceutical manufacturer, pharmacy benefit manager or health benefit plan as defined in ORS 743B.005; or
(B) Third party employment, ownership or control by a covered entity, pharmaceutical manufacturer, pharmacy benefit manager or health benefit plan as defined in ORS 743B.005.
(b) “Covered entity” means a covered entity as defined in 42 U.S.C. 256b(a)(4)(A) and (C) to (G).
(c) “Medical assistance program” means the state program that provides medical assistance as defined in ORS 414.025.
(d) “340B drug” means a covered drug dispensed by a covered entity, as those terms are defined in 42 U.S.C. 256b, that is subject to the cap on amounts required to be paid in 42 U.S.C. 256b(a)(1).
(2) A policy or certificate of health insurance or other contract providing for the reimbursement of the cost of a prescription drug to a resident of this state:
(a) May not exclude coverage of the drug for a particular indication solely on the grounds that the indication has not been approved by the United States Food and Drug Administration if the Health Evidence Review Commission established under ORS 414.688 or the Pharmacy and Therapeutics Committee established under ORS 414.353 determines that the drug is recognized as effective for the treatment of that indication:
(A) In publications that the commission or the committee determines to be equivalent to:
(i) The American Hospital Formulary Service drug information;
(ii) “Drug Facts and Comparisons” (Lippincott-Raven Publishers);
(iii) The United States Pharmacopoeia drug information; or
(iv) Other publications that have been identified by the United States Secretary of Health and Human Services as authoritative;
(B) In the majority of relevant peer-reviewed medical literature; or
(C) By the United States Secretary of Health and Human Services;
(b) For an insured who is enrolled in the medical assistance program:
(A) Except as provided in subsection (3) of this section, may not require a prescription for the drug to be filled or refilled at a mail order pharmacy; or
(B) May not require a prescription for the drug to be filled or refilled at a pharmacy that is not a local pharmacy enrolled in the medical assistance program;
(c) May not discriminate in the reimbursement of a prescription for 340B drugs from other prescription drugs;
(d) May not assess a fee, chargeback, clawback or other adjustment for the dispensing of a 340B drug;
(e) May not exclude a pharmacy from a pharmacy network on the basis that the pharmacy dispenses a 340B drug;
(f) May not restrict the methods by which a 340B drug may be dispensed or delivered;
(g) May not restrict the number of pharmacies within a pharmacy network that may dispense or deliver 340B drugs; or
(h) May require a covered entity to submit a claim for reimbursement of a prescription drug that includes a modifier or other indicator that the drug is a 340B drug unless:
(A) The covered entity has submitted 340B drug data to a third party clearinghouse of the covered entity’s choosing that:
(i) Requests and receives claim data, including pharmacy claims, from covered entities;
(ii) Ensures that claim data submissions by covered entities are complete and accurate;
(iii) Provides manufacturers with validation of a 340B drug that includes requested claim information submitted by a covered entity and allows pharmaceutical manufacturers to identify units of a 340B drug that may be subject to a rebate or discount under a voluntary rebate or discount arrangement and to verify invoices;
(iv) Allows payers, health benefit plans, and pharmacy benefit managers to access only the validated 340B drug claim information that is necessary to verify rebate payments while ensuring data integrity and privacy;
(v) Allows a covered entity the option of submitting claim data on an aggregated retrospective basis that does not require the application of modifiers on individual claims or point-of-sale identification;
(vi) Does not disclose confidential information other than as permitted to perform the purposes of this paragraph;
(vii) Does not collect pricing information regarding drugs that are not 340B drugs;
(viii) Does not sell or otherwise generate revenue by licensing or making available the data described in this section; and
(ix) Does not have a conflict of interest;
(B) The modifier or other indicator is not required by law to prevent a duplicate discount or rebate; or
(C) The claim is not for payment, directly or indirectly, by the state medical assistance program.
(3) Subsection (2)(b)(A) of this section does not prohibit an insurer from requiring a medical assistance recipient to fill or refill a prescription for a specialty drug at a mail order pharmacy that is a specialty pharmacy.
(4) Nothing in subsection (2)(h) of this section requires a pharmacy benefit manager to participate in or subscribe to a clearinghouse.
(5) Required coverage of a prescription drug under this section shall include coverage for medically necessary services associated with the administration of that drug.
(6) Nothing in this section requires coverage for any prescription drug if the United States Food and Drug Administration has determined use of the drug to be contraindicated.
(7) Nothing in this section requires coverage for experimental drugs not approved for any indication by the United States Food and Drug Administration.
(8) Notwithstanding ORS 750.055 (1)(h), this section does not apply to a health maintenance organization as defined in ORS 750.005.
(9) This section is exempt from ORS 743A.001.