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HPA Statute Details

Current HPA Statutes

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Oregon Prescription Drug Program (OPDP)

Wednesday, April 12, 2017


​ORS 414.312 to 414.320

      414.312 Oregon Prescription Drug Program. (1) As used in ORS 414.312 to 414.318:

      (a) "Pharmacy benefit manager" means an entity that 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 Health Authority. The purpose of the program is to:

      (a) Purchase prescription drugs, replenish prescription drugs dispensed 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 as a means to promote health;

      (c) Maintain a list of prescription drugs recommended as the most effective prescription drugs available at the best possible prices; and

      (d) Promote health through the purchase and provision of discount prescription drugs and coordination of comprehensive prescription benefit services for eligible entities and members.

      (3) The Director of the Oregon Health Authority shall appoint an administrator of the Oregon Prescription Drug Program. The administrator may:

      (a) Negotiate price discounts and rebates on prescription drugs with prescription drug manufacturers or group purchasing organizations;

      (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 or replenish pharmacies for prescription drugs dispensed or transferred;

      (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, Oregon Educators Benefit Board and Public Employees Retirement System;

      (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) Oregon Health and Science University established under ORS 353.020;

      (d) State agencies that directly or indirectly purchase prescription drugs, including agencies that dispense prescription drugs directly to persons in state-operated facilities;

      (e) Residents of this state who lack or are underinsured for prescription drug coverage;

      (f) Private entities; and

      (g) Labor organizations.

      (5) The administrator may establish different program prices for pharmacies in rural areas to maintain statewide access to the program.

      (6) The administrator may 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.

      (7) Except as provided in subsection (8) 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.

      (8) The administrator shall contract with one or more entities to perform any of the functions of the program, including but not limited to:

      (a) Contracting with a pharmacy benefit manager and directly or indirectly with such pharmacy networks as the administrator considers necessary to maintain statewide access to the program.

      (b) Negotiating with prescription drug manufacturers on behalf of the administrator.

      (9) Notwithstanding subsection (4)(e) of this section, individuals who are eligible for Medicare Part D prescription drug coverage may participate in the program.

      (10) The program may contract with vendors as necessary to utilize discount purchasing programs, including but not limited to group purchasing organizations established to meet the criteria of the Nonprofit Institutions Act, 15 U.S.C. 13c, or that are exempt under the Robinson-Patman Act, 15 U.S.C. 13. [2003 c.714 §1; 2007 c.2 §1; 2007 c.67 §1; 2007 c.697 §17; 2009 c.263 §2; 2009 c.466 §1; 2009 c.595 §291; 2011 c.720 §136; 2013 c.14 §6; 2015 c.551 §1]

 

      Note: 414.312 to 414.320 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.


      414.314 Application and participation in Oregon Prescription Drug Program; prescription drug charges; fees. (1) An individual or entity described in ORS 414.312 (4) may apply to participate in the Oregon Prescription Drug Program. Participants shall apply on an application provided by the Oregon Health Authority. The authority may charge participants a nominal fee to participate in the program. The authority shall issue a prescription drug identification card to participants of the program.

      (2) The authority shall provide a mechanism to calculate and transmit the program prices for prescription drugs to a pharmacy. The pharmacy shall charge the participant the program price for a prescription drug.

      (3) A pharmacy may charge the participant the professional dispensing fee set by the authority.

      (4) Prescription drug identification cards issued under this section must contain the information necessary for proper claims adjudication or transmission of price data. [2003 c.714 §2; 2007 c.67 §2; 2007 c.697 §18; 2009 c.595 §292]

      Note: See note under 414.312.

      414.316 [2003 c.714 §3; 2007 c.697 §19; 2009 c.595 §293; repealed by 2015 c.318 §56]

      414.318 Prescription Drug Purchasing Fund. The Prescription Drug Purchasing Fund is established separate and distinct from the General Fund. The Prescription Drug Purchasing Fund shall consist of moneys appropriated to the fund by the Legislative Assembly and moneys received by the Oregon Health Authority for the purposes established in this section in the form of gifts, grants, bequests, endowments or donations. The moneys in the Prescription Drug Purchasing Fund are continuously appropriated to the authority and shall be used to purchase prescription drugs, reimburse pharmacies for prescription drugs and reimburse the authority for the costs of administering the Oregon Prescription Drug Program, including contracted services costs, computer costs, professional dispensing fees paid to retail pharmacies and other reasonable program costs. Interest earned on the fund shall be credited to the fund. [2003 c.714 §4; 2007 c.697 §20; 2009 c.595 §294]

      Note: See note under 414.312.

      414.320 Rules. The Oregon Health Authority shall adopt rules to implement and administer ORS 414.312 to 414.318. The rules shall include but are not limited to establishing procedures for:

      (1) Issuing prescription drug identification cards to individuals and entities that participate in the Oregon Prescription Drug Program; and

      (2) Enrolling pharmacies in the program. [2003 c.714 §5; 2007 c.697 §21; 2009 c.595 §295]

      Note: See note under 414.312.
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