Or. Admin. Code § 431-121-2020

Current through Register Vol. 63, No. 12, December 1, 2024

Section 431-121-2020 - Program Price

(1) The price for a prescription drug a pharmacy provider may charge a member under the OPDP is the lesser of the following on the date of the transaction:

(a) The program price, or

(b) The pharmacy provider's usual and customary price, including program cost and dispensing fee.

(2) The designated entity shall transmit the price of the prescription drugs to the pharmacy providers electronically.

(3) The OPDP is limited to prescription drugs prescribed in the name of and for the use by the member, except as otherwise provided in section (7) of this rule.

(4) Prescription drug benefit access shall be available on member identification cards.

(5) The OPDP does not include prescriptions for over-the-counter drugs.

(6) The Administrator, or designated entity, may establish different program prices for CAP providers to maintain statewide access to the OPDP.

(7) Unique pricing arrangements may be agreed upon between pharmacy providers and designated entity to accommodate group purchasing or 340B pricing for qualified entities.

Or. Admin. Code § 431-121-2020

OHP 1-2004, f. & cert. ef. 9-24-04; OHP 2-2006(Temp), f. & cert. ef. 11-28-06 thru 5-23-07; OHP 2-2007(Temp), f. & cert. ef. 5-16-07 thru 11-6-07; OHP 3-2007, f. & cert. ef. 8-3-07; OHP 3-2009, f. & cert. ef. 10-1-09; Renumbered from 409-030-0020 by DMAP 1-2011, f. 2-10-11, cert. ef. 3-1-11; DMAP 10-2012, f. 3-6-12, cert. ef. 3-13-12; Renumbered from 410-121-2020, OPDP 1-2015, f. & cert. ef. 2/18/2015; OPDP 1-2024, amend filed 05/17/2024, effective 5/17/2024

Statutory/Other Authority: ORS 414.320

Statutes/Other Implemented: ORS 414.312 - 414.320