Relating to health care; and prescribing an effective date.
HB 3409 makes targeted changes to Oregon’s pharmacy benefit manager (PBM) and prescription drug coverage laws, with a focus on maximum allowable cost pricing, 340B drug reimbursement, and claim-processing rules. The bill updates statutory definitions related to pharmacies, PBMs, specialty drugs, and 340B drugs/pharmacies, and it tightens requirements for how PBMs build and maintain drug pricing lists. Among other things, PBMs must ensure drugs on maximum allowable cost lists are generally available for purchase, update those lists every seven business days, disclose the nonproprietary sources used to set pricing, and provide pharmacies with searchable electronic list access and a clear appeal process when reimbursement is below acquisition cost.
The bill also adds or reinforces protections for pharmacies and covered entities around payment practices. It prohibits retroactive claim denials or reductions after adjudication except in limited circumstances, bars post-point-of-sale fees, and prevents PBMs from reimbursing 340B pharmacies differently solely because of their 340B status. It further requires detailed denial notices and preserves pharmacy audit authority. These changes are intended to increase transparency and reduce reimbursement practices that can disadvantage pharmacies, especially smaller or critical access pharmacies.
On the health insurance side, HB 3409 amends Oregon’s prescription drug coverage law to prohibit insurers from discriminating against 340B drugs, imposing fees or clawbacks on 340B dispensing, excluding pharmacies from networks because they dispense 340B drugs, or restricting how many network pharmacies may dispense or deliver 340B drugs. It also limits when insurers may require a 340B modifier or other indicator on claims, unless a qualifying third-party clearinghouse process is used or the claim is outside state medical assistance payment. The bill preserves existing rules on medically necessary administration services, contraindicated drugs, experimental drugs, and the exemption for health maintenance organizations.
The general sentiment appears to have been supportive but not unanimous. The bill advanced through both chambers with majority support, including 32-18 in the House and 18-12 in the Senate, and committee votes also favored passage. That pattern suggests broad backing for stronger PBM oversight and 340B-related protections, while also indicating meaningful opposition.
The main points of contention likely centered on the bill’s impact on PBM business practices, insurer flexibility, and 340B claim verification requirements. Opponents may have viewed the new disclosure, appeal, and reimbursement restrictions as burdensome or as limiting cost-management tools, while supporters likely emphasized pharmacy fairness, transparency, and protection against retroactive payment changes and discriminatory treatment of 340B providers. The bill’s detailed clearinghouse provisions also suggest concern about balancing anti-duplicate-discount safeguards with privacy and administrative burden.
HB 3409 amends ORS 735.530, 735.534, and 743A.062, expanding state regulation of pharmacy benefit managers and prescription drug reimbursement practices. It imposes new operational duties on PBMs regarding maximum allowable cost lists, appeals, reimbursement notices, and 340B pharmacy treatment, and it adds restrictions on insurers’ handling of 340B drugs and claim modifiers. The bill takes effect 91 days after adjournment of the 2025 regular session, so it will change how PBMs, pharmacies, covered entities, and insurers administer prescription drug benefits in Oregon once effective.
The bill appears to have been viewed favorably overall by legislative majorities, as shown by passage in both chambers and committee approval. The vote margins, however, indicate that the measure was not broadly unanimous and that some lawmakers remained concerned about its regulatory impact. In general, the discussion implied support for pharmacy reimbursement reform and 340B protections, alongside opposition from those wary of added compliance obligations and limits on PBM/insurer practices.
The most notable disputes likely involved whether the bill goes too far in regulating PBMs and insurers versus whether those controls are necessary to prevent unfair reimbursement practices. Specific flashpoints include the prohibition on retroactive claim reductions, the requirement to update maximum allowable cost lists frequently, the ban on differential reimbursement for 340B pharmacies, and the limits on requiring 340B claim modifiers unless a clearinghouse standard is met. Supporters are likely pharmacies, covered entities, and advocates for transparency; opponents are likely PBMs, insurers, and others concerned about administrative burden, pricing flexibility, and fraud/duplicate-discount prevention.