In Oregon, Governor Tina Kotek recently signed House Bill 4149 (the “Law”) into law which improves the State’s current Pharmacy Benefit Manager (“PBM”) laws including by increasing transparency with additional reasonable PBM regulation in Oregon.
One measure aimed at increasing PBM transparency in Oregon is a requirement that upon request, PBMs will be required to submit to the Department of Consumer and Business Services (the “Department”), contracts and amendments to contracts with pharmacies or pharmacy services administrative organizations. This will shed light on the proverbial “black box” that PBMs often create and use to shelter their confidential contracts from public scrutiny. Furthermore, PBMs must now be licensed by the Department to conduct business in Oregon and the license must be renewed every 12 months. The licensure requirements will have certain rules and obligations that must be complied with as a condition of continued licensure in Oregon.
The Law also increases reasonable PBM regulation by allowing pharmacies to file complaints against PBMs with the Department. The complaint process will now allow an independent third-party, the Department, to monitor, prevent, and potentially penalize PBMs for any improper conduct under the applicable laws. PBMs are also now expressly prohibited from retaliating against pharmacies for utilizing and enforcing their rights by challenging PBM conduct whether it be by an audit appeal or filing a complaint with the Department.
Oregon’s new Law is a positive development for Oregon’s independent pharmacies. It also helps to address the concern of PBMs conducting business without any means for independent pharmacies to challenge PBMs’ improper business practices. Pharmacies and pharmacists should become familiar with this new Law including the complaint process referenced herein. The Department’s involvement in overseeing unjust PBM conduct could lead to significant improvements in pharmacies’ ability to conduct business in Oregon and provide additional legal rights when facing challenges with PBMs.
How Frier Levitt Can Help
Frier Levitt represents numerous pharmacies across the United States in challenging PBM audits, network access, reimbursement practices and other complex issues such as DIR fees. Our attorneys have extensive knowledge in all aspects of the pharmacy-PBM relationship. Contact us to speak with an attorney about how your pharmacy can leverage the various applicable laws and protections afforded to pharmacies that regulate PBM conduct.
