Bill > HB2011

This bill establishes new regulations for health insurers and pharmacy benefit managers (PBMs) regarding prescription drug coverage, specifically focusing on physician-administered drugs obtained from non-participating pharmacies. The bill defines key terms like "participating pharmacy" (a pharmacy that contracts with an insurer or PBM) and "physician-administered drug" (a prescription drug requiring administration by a health professional). It prohibits insurers and PBMs from denying or restricting coverage of such drugs if they are covered under the policy, medically necessary, and meet federal supply chain security requirements. The bill prevents insurers from imposing different coverage conditions, reimbursement rates, or out-of-pocket costs based on the pharmacy's participation status, and specifically states that medical necessity criteria cannot be based on the location of the healthcare provider administering the drug. Additionally, the bill allows insurers to establish centers of excellence based on objective quality measures. Violations of these provisions are considered an unlawful practice under Oregon's consumer protection laws, which could result in legal action. The primary aim is to ensure patients have consistent and fair access to necessary prescription drugs, regardless of the pharmacy's network status.

Health and Social Services

https://olis.oregonlegislature.gov/liz/2025R1/Measures/Overview/HB2011