Bill Text: OR SB402 | 2013 | Regular Session | Introduced

---

Bill Title: Relating to pharmacy benefit managers; declaring an emergency.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Failed) 2013-07-08 - In committee upon adjournment. [SB402 Detail]

Download: Oregon-2013-SB402-Introduced.html

---

     77th OREGON LEGISLATIVE ASSEMBLY--2013 Regular Session

NOTE:  Matter within  { +  braces and plus signs + } in an
amended section is new. Matter within  { -  braces and minus
signs - } is existing law to be omitted. New sections are within
 { +  braces and plus signs + } .

LC 1617

                         Senate Bill 402

Sponsored by Senator BATES (Presession filed.)

                             SUMMARY

The following summary is not prepared by the sponsors of the
measure and is not a part of the body thereof subject to
consideration by the Legislative Assembly. It is an editor's
brief statement of the essential features of the measure as
introduced.

  Specifies requirements for reimbursement of covered drugs by
pharmacy benefit manager.
  Declares emergency, effective on passage.

                        A BILL FOR AN ACT
Relating to pharmacy benefit managers; and declaring an
  emergency.
Be It Enacted by the People of the State of Oregon:
  SECTION 1.  { + (1) As used in this section:
  (a) 'List' means the list of drugs for which a third party
administrator has established maximum allowable costs.
  (b) 'Maximum allowable cost' means the maximum amount that a
third party administrator will pay toward the cost of a drug.
  (c) 'Nationally available' means that all pharmacies in this
state can purchase the drug without limitation from regional or
national wholesalers and the product is not obsolete or
temporarily available.
  (d) 'Pharmacy' means a retail drug outlet registered under ORS
689.305.
  (e) 'Therapeutically equivalent' means the drug is identified
as therapeutically or pharmaceutically equivalent or ' A' rated
by the United States Food and Drug Administration.
  (2) In any contract between a third party administrator and a
pharmacy, the third party administrator shall:
  (a) Specify the methodology and sources used to determine
maximum allowable costs;
  (b) Set forth an administrative appeal procedure for a pharmacy
to contest the maximum allowable cost that ensures the third
party administrator makes a determination no later than 15 days
after the pharmacy initiates the appeal; and
  (c) Specify the process for making changes to the list or to
the maximum allowable cost for any drug on the list.
  (3) If a pharmacy contests a maximum allowable cost under
subsection (2)(b) of this section and the third party
administrator adjusts the maximum allowable cost for a drug or
removes the drug from the list, the adjustment shall apply to all
pharmacies contracting with the third party administrator and the
new reimbursement rate shall be retroactive to the date that the
pharmacy dispensed the drug that was the subject of the contested
claim.

  (4) A third party administrator that contracts with an insurer
or other payer to process claims for prescription drugs:
  (a) May not include a drug on a the third party administrator's
list unless there are at least three nationally available,
therapeutically equivalent drugs available for purchase at a
significant cost difference;
  (b) Shall update the maximum allowable cost for drugs on the
list no less than every seven calendar days and shall promptly
notify pharmacies, insurers and payers of any changes;
  (c) Shall establish a procedure for removing drugs from the
list in a timely manner;
  (d) May not add a drug to the list or must promptly remove a
drug from the list if the criteria of paragraph (a) of this
subsection are not met with respect to the drug;
  (e) Shall inform the insurer or payer if the third party
administrator applies a maximum allowable cost to drugs dispensed
through a pharmacy but not through a mail order service; and
  (f) Shall notify the insurer or payer if the third party
administrator does not use the same list for billing the insurer
or payer as it uses in reimbursing pharmacies. If there is a
difference between the list used for billing an insurer or payer
and the list used for reimbursing pharmacies, the third party
administrator shall inform the insurer or payer of the difference
between the maximum allowable cost charged to the insurer or
payer and the maximum allowable cost paid to a pharmacy. + }
  SECTION 2.  { + Section 1 of this 2013 Act applies to contracts
between third party administrators and pharmacies, insurers and
other payers entered into or renewed on or after the effective
date of this 2013 Act. + }
  SECTION 3.  { + This 2013 Act being necessary for the immediate
preservation of the public peace, health and safety, an emergency
is declared to exist, and this 2013 Act takes effect on its
passage. + }
                         ----------