ORS 735.536
Requirements for pharmacy benefit manager’s reimbursement for cost of drugs

  • rules

(1)

As used in this section, “out-of-pocket cost” means the amount paid by an enrollee under the enrollee’s coverage, including deductibles, copayments, coinsurance or other expenses as prescribed by the Department of Consumer and Business Services by rule.

(2)

A pharmacy benefit manager registered under ORS 735.532 (Registration of pharmacy benefit managers):

(a)

May not require a prescription to be filled or refilled by a mail order pharmacy as a condition for reimbursing the cost of the drug.

(b)

Except as provided in paragraph (c) of this subsection, may require a prescription for a specialty drug to be filled or refilled at a specialty pharmacy as a condition for the reimbursement of the cost of a drug.

(c)

Shall reimburse the cost of a specialty drug that is filled or refilled at a network pharmacy that is a long term care pharmacy.

(d)

Intentionally left blank —Ed.

(A)

Shall allow a network pharmacy to mail, ship or deliver prescription drugs to its patients as an ancillary service.

(B)

Is not required to reimburse a delivery fee charged by a pharmacy for a delivery described in subparagraph (A) of this paragraph unless the fee is specified in the contract between the pharmacy benefit manager and the pharmacy.

(e)

May not require a patient signature as proof of delivery of a mailed or shipped prescription drug if the network pharmacy:

(A)

Intentionally left blank —Ed.
(i)
Maintains a mailing or shipping log signed by a representative of the pharmacy; or
(ii)
Maintains each notification of delivery provided by the United States Postal Service or a package delivery service; and

(B)

Is responsible for the cost of mailing, shipping or delivering a replacement for a drug that was mailed or shipped but not received by the enrollee.

(f)

May not penalize a network pharmacy for or otherwise directly or indirectly prevent a network pharmacy from informing an enrollee of the difference between the out-of-pocket cost to the enrollee to purchase a prescription drug using the enrollee’s pharmacy benefit and the pharmacy’s usual and customary charge for the prescription drug.

(3)

The Department of Consumer and Business Services may adopt rules to carry out the provisions of this section. [2019 c.526 §2]
Note: See note under 735.530 (Definitions for ORS 735.530 to 735.552).

Source: Section 735.536 — Requirements for pharmacy benefit manager’s reimbursement for cost of drugs; rules, https://www.­oregonlegislature.­gov/bills_laws/ors/ors735.­html (accessed May 26, 2025).

735.005
Definitions for ORS 735.005 to 735.145 735.015
Purpose 735.025
Construction 735.035
Application 735.045
Oregon FAIR Plan Association 735.055
Association board of directors 735.065
Required association functions 735.075
Discretionary association functions 735.085
Plan of operation 735.095
Contents of plan of operation 735.105
Regulation of association as insurer 735.115
Exemption of association from fees and taxes 735.145
Immunity from legal action in carrying out duties 735.150
Definitions for ORS 735.150 to 735.190 735.152
Application of laws 735.154
Rules 735.156
Confidentiality of documents and materials 735.158
Certificate of authority 735.160
Business name 735.162
Capital and surplus requirements 735.164
Incorporation of pure captive insurer and association captive insurer 735.166
Investment requirements for association captive insurer 735.168
Allowable risks for captive insurer 735.170
Rating organization 735.172
Reporting 735.174
Examination 735.176
Compliance with sound actuarial principles 735.178
Suspension or revocation of certificate of authority 735.180
Branch captive insurer as pure captive insurer 735.182
Examination of branch captive insurer and alien captive insurer 735.184
Requirements for foreign captive insurer to provide insurance in this state 735.186
Management of assets of captive reinsurer 735.188
Application of captive reinsurer for certificate of authority 735.190
Incorporation of captive reinsurer 735.200
Legislative findings 735.205
Definitions for ORS 735.200 to 735.260 735.210
Formation of market assistance plans 735.215
Findings prior to formation of joint underwriting association 735.220
Formation of joint underwriting association 735.225
Membership in joint underwriting association 735.230
Rates 735.235
Board of directors 735.240
Annual statement 735.245
Conditions for policyholder surcharge 735.250
Exemption from liability 735.255
State not liable to pay debts of association 735.260
Rules 735.265
Liquor liability insurance risk and rate classifications 735.300
Purpose of ORS 735.300 to 735.365 735.305
Definitions for ORS 735.300 to 735.365 735.310
Qualifications for risk retention group 735.315
Foreign risk retention groups 735.320
Relationship to insurance guaranty fund and joint underwriting association 735.325
Exemption of purchasing groups from certain laws 735.330
Purchasing groups 735.335
Purchase of insurance by purchasing group 735.340
Insurance Code enforcement authority subject to federal law 735.345
Violation of 735.300 to 735.365 735.350
Agent or broker 735.355
Court orders enforceable in Oregon 735.360
Rules 735.365
Short title 735.400
Purposes of ORS 735.400 to 735.495 735.405
Definitions for ORS 735.400 to 735.495 735.406
Cost of living adjustment to net worth, revenues and expenses of exempt commercial purchasers 735.410
Conditions for procuring insurance through nonadmitted insurer 735.415
Qualifications for placement of coverage with nonadmitted insurer 735.417
Insured required to report and pay taxes on independently procured insurance covering Oregon home state risks 735.418
Director authorized to enter into interstate compact for premium tax allocation 735.420
Declaration of ineligibility of surplus lines insurer 735.425
Filing by licensee after placement of surplus lines insurance 735.430
Surplus Line Association of Oregon 735.435
Evidence of insurance 735.440
Validity of contracts 735.445
Effect of payment of premium to surplus lines licensee 735.450
Requirements for license as surplus lines insurance licensee 735.455
Authority of licensee 735.460
Records of licensee 735.465
Monthly reports 735.470
Premium tax 735.475
Suit to recover unpaid tax 735.480
Suspension or revocation of license 735.485
Actions against surplus lines insurer 735.490
Jurisdiction in action against insurer 735.492
Application of certain Insurance Code provisions to surplus lines insurers 735.495
Short title 735.500
Requirements for certification as retainer medical practice 735.510
Notice to department of specified changes to practice 735.515
Charges for services not covered by contract 735.520
Oregon Essential Workforce Health Care Program 735.530
Definitions for ORS 735.530 to 735.552 735.532
Registration of pharmacy benefit managers 735.533
Denial, suspension or revocation of registration as pharmacy benefit manager 735.534
Claim reimbursement 735.536
Requirements for pharmacy benefit manager’s reimbursement for cost of drugs 735.537
Reports to department regarding payments received from manufacturers and disposition of payments from manufacturers 735.540
Definitions for ORS 735.540 to 735.552 735.542
Pharmacy claims audits 735.544
Pharmacy claims audits 735.546
Pharmacy claims audits 735.548
Pharmacy claims audits 735.550
Pharmacy claims audits 735.552
Pharmacy claims audits 735.631
Definitions for ORS 735.631 to 735.643 735.632
License requirement for conducting business as discount medical plan organization 735.633
Requirement for contract with provider 735.634
License application 735.636
Duties of licensee 735.637
License term 735.638
Duties of discount medical plan organization 735.639
Prohibited activities 735.641
Investigative powers of director 735.642
License suspension, revocation or failure to renew 735.643
Injunction

Current through early 2026

§ 735.536. Requirements for pharmacy benefit manager’s reimbursement for cost of drugs's source at oregon​.gov