Leading Pharmacy, Advancing Healthcare

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Oregon Pharmacy PBM Study

In early 2022, shortly after the Bi-Mart pharmacy closures, OSPA hired 3 Axis Advisors to review reimbursement trends between payers and retail pharmacies between 2019 and 2021. The primary request was to identify if there may be differential pricing in payment or spread pricing among Oregon Medicaid retail pharmacy networks, which could compromise the sustainability of some providers and/or create barriers to care to some Oregonians. We had over 80 pharmacies volunteer their data to participate in this monumental study.

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What to do if a PBM is in violation of the law?

  • Step 1- make an appeal to the PBM or contact them directly about the violation of the law.
  • Step 2- escalate the appeal if you don’t get results. Give them written quotes or copies of the law.  Get your PSAO (Pharmacy Services Administration Organization) involved if you have one.  PBMs do want to be compliant if you can get to someone of responsibility.
  • Step 3- file a complaint with the Department of Consumer and Business Services

Division of Financial Regulation : File a complaint : File a complaint or check a license : State of Oregon

  • Contact OSPA for help or advise. We want to know what is happening and if complaints are being filed with DCBS.

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SAVE THE DATE

Lane County Mid-Winter CE Seminar

February 25-26, 2023

Graduate Hotel – Eugene

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PBM Drug Pricing

In the 31 states where the amount paid for this generic multiple sclerosis drug was reported, it’s estimated that states nationally overpaid by nearly $47 million compared to the manufacturer list price for the medication – roughly $3,000 per perscription.

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