ORS 735.530
Definitions for ORS 735.530 to 735.552
(1)
“Claim” means a request from a pharmacy or pharmacist to be reimbursed for the cost of filling or refilling a prescription for a drug or for providing a medical supply or service.(2)
“Enrollee” means an individual who has enrolled for coverage in a health benefit plan for which a pharmacy benefit manager has contracted with the insurer to reimburse claims submitted by pharmacies or pharmacists for the costs of drugs prescribed for the individual.(3)
“Health benefit plan” has the meaning given that term in ORS 743B.005 (Definitions).(4)
“Insurer” has the meaning given that term in ORS 731.106 (“Insurer.”).(5)
“Long term care pharmacy” means a pharmacy for which the primary business is to serve a:(a)
Licensed long term care facility, as defined in ORS 442.015 (Definitions);(b)
Licensed residential facility, as defined in ORS 443.400 (Definitions for ORS 443.400 to 443.455); or(c)
Licensed adult foster home, as defined in ORS 443.705 (Definitions for ORS 443.705 to 443.825).(6)
“Mail order pharmacy” means a pharmacy for which the primary business is to receive prescriptions by mail, telephone or electronic transmission and dispense drugs to patients through the use of the United States Postal Service, a package delivery service or home delivery.(7)
“Network pharmacy” means a pharmacy that contracts with a pharmacy benefit manager.(8)
“Pharmacist” has the meaning given that term in ORS 689.005 (Definitions).(9)
“Pharmacy” includes:(a)
A pharmacy as defined in ORS 689.005 (Definitions);(b)
A long term care pharmacy; and(c)
An entity that provides or oversees administrative services for two or more pharmacies.(10)
“Pharmacy benefit” means the payment for or reimbursement of an enrollee’s cost for prescription drugs.(11)
Intentionally left blank —Ed.(a)
“Pharmacy benefit manager” means a person that contracts with pharmacies on behalf of an insurer offering a health benefit plan, a third party administrator or the Oregon Prescription Drug Program established in ORS 414.312 (Oregon Prescription Drug Program) to:(A)
Process claims for prescription drugs or medical supplies or provide retail network management for pharmacies or pharmacists;(B)
Pay pharmacies or pharmacists for prescription drugs or medical supplies; or(C)
Negotiate rebates with manufacturers for drugs paid for or procured as described in this paragraph.(b)
“Pharmacy benefit manager” does not include a health care service contractor as defined in ORS 750.005 (Definitions).(12)
“Specialty drug” means a drug that:(a)
Is subject to restricted distribution by the United States Food and Drug Administration; or(b)
Requires special handling, provider coordination or patient education that cannot be provided by a retail pharmacy.(13)
“Specialty pharmacy” means a pharmacy capable of meeting the requirements applicable to specialty drugs.(14)
“Third party administrator” means a person licensed under ORS 744.702 (Third party administrator license).(15)
“340B pharmacy” means a pharmacy that is authorized to purchase drugs at a discount under 42 U.S.C. 256b. [2013 c.570 §2; 2017 c.73 §5; 2019 c.526 §3]
Source:
Section 735.530 — Definitions for ORS 735.530 to 735.552, https://www.oregonlegislature.gov/bills_laws/ors/ors735.html.
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