Chapter 2
AN ACT
Relating to prescription drugs; amending ORS 414.312.
Be It Enacted by the People of
the State of
SECTION 1.
ORS 414.312 is amended to read:
414.312. (1) As used in
ORS 414.312 to 414.318:
(a) “Pharmacy benefit
manager” means an entity that, in addition to being a prescription drug claims
processor, negotiates and executes contracts with pharmacies, manages preferred
drug lists, negotiates rebates with prescription drug manufacturers and serves
as an intermediary between the Oregon Prescription Drug Program, prescription
drug manufacturers and pharmacies.
(b) “Prescription drug
claims processor” means an entity that processes and pays prescription drug
claims, adjudicates pharmacy claims, transmits prescription drug prices and
claims data between pharmacies and the Oregon Prescription Drug Program and
processes related payments to pharmacies.
(c) “Program price”
means the reimbursement rates and prescription drug prices established by the
administrator of the Oregon Prescription Drug Program.
(2) The Oregon
Prescription Drug Program is established in the Oregon Department of
Administrative Services. The purpose of the program is to:
(a) Purchase
prescription drugs or reimburse pharmacies for prescription drugs in order to
receive discounted prices and rebates;
(b) Make prescription
drugs available at the lowest possible cost to participants in the program; and
(c) Maintain a list of
prescription drugs recommended as the most effective prescription drugs available
at the best possible prices.
(3) The Director of the
Oregon Department of Administrative Services shall appoint an administrator of
the Oregon Prescription Drug Program. The administrator shall:
(a) Negotiate price
discounts and rebates on prescription drugs with prescription drug
manufacturers;
(b) Purchase
prescription drugs on behalf of individuals and entities that participate in
the program;
(c) Contract with a
prescription drug claims processor to adjudicate pharmacy claims and transmit
program prices to pharmacies;
(d) Determine program
prices and reimburse pharmacies for prescription drugs;
(e) Adopt and implement
a preferred drug list for the program;
(f) Develop a system for
allocating and distributing the operational costs of the program and any
rebates obtained to participants of the program; and
(g) Cooperate with other
states or regional consortia in the bulk purchase of prescription drugs.
(4) The following
individuals or entities may participate in the program:
(a) Public Employees’
Benefit Board;
(b) Local governments as
defined in ORS 174.116 and special government bodies as defined in ORS 174.117
that directly or indirectly purchase prescription drugs;
(c) Enrollees in the
Senior Prescription Drug Assistance Program created under ORS 414.342;
(d) Oregon Health and
(e) State agencies that
directly or indirectly purchase prescription drugs, including agencies that
dispense prescription drugs directly to persons in state-operated facilities;
and
(f) Residents of this
state who[:]
[(A) Are more than 54 years of age;]
[(B) Have a gross annual income that does not exceed 185 percent of the
federal poverty guidelines; and]
[(C) Have not been covered under any private prescription drug benefit
program for the previous six months] do not have prescription drug
coverage.
(5) The state agency
that receives federal Medicaid funds and is responsible for implementing the
state’s medical assistance program may not participate in the program.
(6) The administrator
may establish different reimbursement rates or prescription drug prices for
pharmacies in rural areas to maintain statewide access to the program.
(7) The administrator
shall establish the terms and conditions for a pharmacy to enroll in the
program. A licensed pharmacy that is willing to accept the terms and conditions
established by the administrator may apply to enroll in the program.
(8) Except as provided
in subsection (9) of this section, the administrator may not:
(a) Contract with a
pharmacy benefit manager;
(b) Establish a
state-managed wholesale or retail drug distribution or dispensing system; or
(c) Require pharmacies
to maintain or allocate separate inventories for prescription drugs dispensed
through the program.
(9) The administrator
shall contract with one or more entities to provide the functions of a
prescription drug claims processor. The administrator may also contract with a
pharmacy benefit manager to negotiate with prescription drug manufacturers on behalf
of the administrator.
(10) Notwithstanding
subsection (4)(f) of this section, individuals who are eligible for Medicare
Part D prescription drug coverage may participate in the program.
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The Act set forth above
(Ballot Measure No. 44) was proposed by initiative petition and was approved by
the voters at the regular general election on November 7, 2006. By proclamation
of the Governor dated December 7, 2006, the Act was declared to have received
an affirmative majority of the total number of votes cast thereon and to be in
full force and effect as Approved by the Governor provided in section 1,
Article IV, Oregon Constitution (i.e., on December 7, 2006).
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NOTE: The Legislative Counsel Committee has not
adjusted the format of the ORS citations in the text that was proposed by
initiative petition and approved by the Effective date voters.
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