Oregon Administrative Rules
Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION
Division 53 - HEALTH BENEFIT PLANS
Section 836-053-1630 - Drug Price Transparency Insurer Reporting

Universal Citation: OR Admin Rules 836-053-1630

Current through Register Vol. 63, No. 9, September 1, 2024

(1) For the purposes of this rule, "insurer" means a licensed insurance company, health care services contractor, or health maintenance organization that issues health benefit plans as defined in ORS 743B.005(16) in this state.

(2) No later than May 1 of each year, an insurer with 200 or more enrollees in the state of Oregon must report to the department the information described in ORS 743.025(2) in the form and manner prescribed by the department. For drugs reimbursed by the insurer under both pharmacy and medical benefits in health benefit plans during the prior calendar year, the reporting must include all of the following:

(a) The 25 most frequently prescribed drugs.

(b) The 25 most costly drugs. In determining this list, the insurer must consider total annual spending, including the net impact of any rebates or other price concessions if applicable.

(c) The 25 drugs that have caused the greatest increase in total plan spending from one year to the next. In determining this list, the insurer must consider the net impact on total plan spending of any rebates or other price concessions if applicable.

(d) The impact of the costs of prescription drugs on premium rates, on a per member per month basis, including the net impact of any rebates or other price concessions if applicable.

Statutory/Other Authority: ORS 731.244

Statutes/Other Implemented: ORS 743.025 & 735.537

Disclaimer: These regulations may not be the most recent version. Oregon may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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