Requires insurer, pharmacy benefit manager, Public Employees' Benefit Board, Oregon Educators Benefit Board and health care service contractor to count payments made by or on behalf of enrollee for costs of certain prescription drugs when calculating enrollee's contribution to out-of-pocket maximum, deductible, copayment, coinsurance or other cost-sharing for drugs.
Requires Oregon Health Authority, every three years, to conduct survey of retail pharmacies enrolled as providers in state medical assistance program regarding pharmacies' dispensing costs.
Establishes Universal Health Plan Governance Board and directs board to create comprehensive plan for implementing Universal Health Plan .
Specifies that health professional licensee may not be required to have physical address in this state for eligibility for authorization to practice health profession.
Requires Oregon Health Authority to adopt standards for types of data collected for all payer, all claims database that are consistent with standards adopted for collection of data on race, ethnicity, language, disability, sexual orientation and gender identity.
Allows Oregon Health Authority to reimburse coordinated care organizations using payment mechanisms other than global budgets under specified circumstances.
Establishes Universal Health Plan Governance Board and directs board to create comprehensive plan for implementing Universal Health Plan beginning in 2027.
Prohibits health insurers and pharmacy benefit managers from restricting coverage of physician-administered prescription drugs that are obtained by nonparticipating pharmacies.
Prohibits specified practices by insurers and pharmacy benefit managers in reimbursing cost of prescription drugs. May not discriminate against a 340B pharmacy in a manner that prevents or interferes with an enrollee’s choice to receive drugs from the pharmacy by reimbursing a 340B pharmacy less than any other network pharmacy or imposing a fee, charge-back or other adjustment on a claim for reimbursement based on a pharmacy’s status as a 340B pharmacy.
Prohibits pharmacy benefit manager from retroactively denying or reducing payment on claim after adjudication unless pharmacy and pharmacy benefit manager agree that payment was incorrect due to clerical error. Prohibits pharmacy benefit manager from imposing fees on rural] pharmacies after point of sale. Requires pharmacy benefit manager, if denying or reducing reimbursement on claim, to provide notice to pharmacy of specific claim that is denied or reduced and explanation for denial or reduction.
