(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.
Statutory/Other Authority
ORS 414.320
Statutes/Other Implemented
ORS 414.312 - 414.320
History
OPDP 1-2024, amend filed 05/17/2024, effective 05/17/2024
Renumbered from 410-121-2020, OPDP 1-2015, f. & cert. ef. 2-18-15
DMAP 10-2012, f. 3-6-12, cert. ef. 3-13-12
Renumbered from 409-030-0020 by DMAP 1-2011, f. 2-10-11, cert. ef. 3-1-11
OHP 3-2009, f. & cert. ef. 10-1-09
OHP 3-2007, f. & cert. ef. 8-3-07
OHP 2-2007(Temp), f. & cert. ef. 5-16-07 thru 11-6-07
OHP 2-2006(Temp), f. & cert. ef. 11-28-06 thru 5-23-07
OHP 1-2004, f. & cert. ef. 9-24-04