Bill > HB3212

This bill introduces comprehensive changes to the regulation of pharmacy benefit managers (PBMs) and prescription drug benefits in Oregon. The legislation establishes new requirements for PBMs, including prohibiting spread pricing, mandating transparent and fair reimbursement practices, and preventing discriminatory actions against pharmacies. Key provisions include requiring PBMs to update drug pricing lists every seven business days, provide detailed explanations for claim denials, offer the same contract terms to network and out-of-network pharmacies, and establish a robust appeals process for pharmacies challenging reimbursement rates. The bill also prevents PBMs from retroactively denying claims, imposing post-sale fees, or discriminating against 340B pharmacies (healthcare providers that can purchase outpatient drugs at discounted rates). Additionally, the legislation ensures that health insurance policies cannot exclude coverage for drugs deemed effective by specified medical review committees, restrict pharmacy network participation, or limit patients' choices of pharmacies. These changes aim to increase transparency, fairness, and accessibility in prescription drug pricing and pharmacy services, ultimately protecting both pharmacies and patients from potentially exploitative practices by pharmacy benefit managers.

Health and Social Services

https://olis.oregonlegislature.gov/liz/2025R1/Measures/Overview/HB3212