Or. Admin. Code § 836-200-0418 - [Effective until 6/29/2025] Aggregated Rebate and Payment Reports
(1) For the
purposes of this rule, "health benefit plan" has the meaning defined in ORS
743B.005(16).
(2) For the purposes of this rule, "pharmacy
benefit manager" has the meaning defined in ORS
735.530.
(3) For the purposes of this rule
"administrative fee" has the meaning defined in ORS
735.537(a).
(4) For the purposes of this rule,
"dispensing fee" means an amount paid to a pharmacy for dispensing a
prescription in addition to reimbursement for the cost of the drug;
(5) No later than June 1 of each year, a
pharmacy benefit manager required to be licensed with the Department of
Consumer and Business Services must file a report using the form and manner
prescribed by the department. The report must contain the following information
for the immediately preceding calendar year:
(a) The aggregated amount of rebates, fees,
price protection payments, and any other payments the pharmacy benefit manager
received from manufacturers related to managing the pharmacy benefits for
carriers issuing health benefit plans in this state. This amount must include
payments that the pharmacy benefit manager received from manufacturers directly
and payments the pharmacy benefit manager received from manufacturers by the
pharmacy benefit manager's subsidiaries, any other entities that the pharmacy
benefit manager holds an ownership in, or any entities which hold an ownership
interest in the pharmacy benefit manager. This includes:
(A) The aggregated amount of any payments, as
described in subsection (5)(a) of this rule, that were passed on to carriers
issuing health benefit plans in this state.
(B) The aggregated amount of any payments, as
described in subsection (5)(a) of this rule, that were passed on to enrollees
in a health benefit plan at the point of sale in this state.
(C) The aggregated amount of any payments, as
described in subsection (5)(a) of this rule, that were retained as revenue by
the pharmacy benefit manager.
(b) The amount described in section (5)(a) of
this rule should be equal to the sum of the amounts described in sections
(5)(A)(a), (5)(A)(b), and (5)(A)(c) of this rule.
(c) The total dispensing fees paid to the
pharmacy benefit manager in this state from insurers, coordinated care
organizations, and the Oregon Prescription Drug Program.
(d) The total dispensing fees paid to
pharmacies in this state by the pharmacy benefit manager.
(e) The total administrative fees received
from manufacturers and carriers.
(f) The total administrative fees as
described in subsection (e) that were retained by the pharmacy benefit
manager.
(g) The total amount of
revenue received by the pharmacy benefit manager through spread pricing,
pay-for-performance arrangements, or similar means.
Notes
Statutory/Other Authority: ORS 731.244 & 743.025
Statutes/Other Implemented: ORS 735.537
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