(1) A prescription drug benefit program, or a prescription drug benefit offered under a health benefit plan as defined in ORS 743B.005, must provide for reimbursement for up to a 90-day supply of a prescription drug dispensed by a pharmacy, as defined in ORS 689.005, if:
- (a) The prescription drug is covered by the program or plan;
- (b) An initial 30-day supply of the prescription drug has been previously dispensed to the program or plan member; and
- (c) The quantity of the prescription drug dispensed does not exceed the total remaining quantity of the prescription drug that the prescribing practitioner authorized to be dispensed through refills.
- (2) The coverage required by subsection (1) of this section may be limited by the terms and conditions of a pharmacy network contract, or a prescription drug benefit program or health benefit plan, that are related to the reimbursement rate of the prescription drug.
- (3) The coverage required by subsection (1) of this section may be limited by formulary restrictions that are related to the prescription drug.
- (4) This section does not apply to the reimbursement of prescription drugs classified as a controlled substance in Schedule II.
- (5) This section is exempt from ORS 743A.001.
Note: 743A.063 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743A or any series therein. See Preface to Oregon Revised Statutes for further explanation.
[2015 c.661 §2]