Oregon pharmacists support PBM reforms

March 12, 2013

 

Community pharmacists in Oregon are asking their state lawmakers to support three legislative proposals that would provide greater transparency for determining rates that pharmacies pay for dispensing generic drugs, fairer pharmacy audit standards, and patient choice legislation, according to the National Community Pharmacists Association (NCPA).

S.B. 402 would provide greater insights into how pharmacy benefit managers (PBMs) determine maximum allowable costs (MACs) that they pay pharmacies for dispensing generic drugs as well as the rates that the PBMs will bill the plan sponsor for those claims. This bill would help pharmacists know how MAC reimbursement rates are set, require that the rates are updated when drug costs increase, and put an appeals process in place when disputes arise, NPCA said.

“Similar legislation is moving forward in Kentucky, North Dakota, and Oklahoma,” according to NCPA.

H.B. 2123 would establish better standards for pharmacy audits and require that PBMs register and are licensed by the Oregon State Board of Pharmacy. It also includes the same MAC disclosure and updating requirements outlined in S.B. 402.

S.B. 363 would allow patients in Oregon to choose where they want to fill their prescriptions-without the risk of higher costs. Some health plans have required that patients use out-of-state mail-order pharmacies for “maintenance” prescriptions. This bill would allow them to transfer their prescriptions to community pharmacies in their state if the community pharmacies accept the same level of reimbursement as the mail-order pharmacy.

“This legislation will help prescription drug programs work more efficiently for employers, fairly for pharmacists, and ensure more of Oregon healthcare dollars contribute to local jobs and small businesses,” said Michele Belcher, pharmacist and owner of Grants Pass Pharmacy, Grants Pass, Ore., in a prepared statement.