(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:

Ask an insurance law question, get an answer ASAP!
Click here to chat with a lawyer about your rights.

Terms Used In Oregon Statutes 743A.063

  • Contract: A legal written agreement that becomes binding when signed.

(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. [2015 c.661 § 2]

 

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.