As used in ORS 735.530 to 735.552: (1) Claim means a request from a pharmacy or pharmacist to be reimbursed for the cost of filling or refilling a prescription for a drug or for providing a medical supply or service. (2) Enrollee means an individual who has enrolled for coverage in a health benefit plan for which a pharmacy benefit manager has contracted with the insurer to reimburse claims submitted by pharmacies or pharmacists for the costs of drugs prescribed for the individual. (3) Health benefit plan has the meaning given that term in ORS 743B.005. (4) Insurer has the meaning given that term in ORS 731.106. (5) Long term care pharmacy means a pharmacy for which the primary business is to serve a: (a) Licensed long term care facility, as defined in ORS 442.015; (b) Licensed residential facility, as defined in ORS 443.400; or (c) Licensed adult foster home, as defined in ORS 443.705. (6) Mail order pharmacy means a pharmacy for which the primary business is to receive prescriptions by mail, telephone or electronic transmission and dispense drugs to patients through the use of the United States Postal Service, a package delivery service or home delivery. (7) Network pharmacy means a pharmacy that contracts with a pharmacy benefit manager. (8) Pharmacist has the meaning given that term in ORS 689.005. (9) Pharmacy means: (a) A pharmacy as defined in ORS 689.005; (b) A long term care pharmacy; and (c) An entity that provides or oversees administrative services for two or more pharmacies, including a pharmacy services administrative organization, as defined in ORS 735.538, or a similar or related organization that advises or represents pharmacies that are members of the organization, or enters into contracts on behalf of members, in matters that are related to procuring or supplying prescription drugs. (10) Pharmacy benefit means the payment for or reimbursement of an enrollees cost for prescription drugs. (11)(a) Pharmacy benefit manager means a person that contracts with pharmacies on behalf of an insurer, coordinated care organizations as defined in ORS 414.025 or the Oregon Prescription Drug Program established in ORS 414.312 to: (A) Process claims for prescription drugs or medical supplies or provide retail network management for pharmacies or pharmacists; (B) Pay pharmacies or pharmacists for prescription drugs or medical supplies; (C) Negotiate rebates, discounts or other financial incentives or arrangements with manufacturers for drugs paid for or procured as described in this paragraph; (D) Receive payments for pharmacy services; (E) Disburse or distribute rebates; (F) Manage or participate in incentive programs or arrangements with manufacturers of drugs; (G) Negotiate or enter into contracts with pharmacies; (H) Develop formularies; (I) Design pharmacy benefit programs; or (J) Advertise or promote pharmacy services. (b) Pharmacy benefit manager does not include a health care service contractor as defined in ORS 750.005. (12) Pharmacy services means the provision of products, goods or services in the course of the practice of pharmacy. (13) Specialty drug means a drug that: (a) Is subject to restricted distribution by the United States Food and Drug Administration; or (b) Requires special handling, provider coordination or patient education that cannot be provided by a retail pharmacy. (14) Specialty pharmacy means a pharmacy capable of meeting the requirements applicable to specialty drugs. (15) Third party administrator means a person licensed under ORS 744.702. (16) 340B drug means a covered drug that is subject to the cap on amounts required to be paid in 42 U.S.C. 256b(a)(1) and that is dispensed at a 340B pharmacy. (17) 340B pharmacy means a pharmacy that is authorized to purchase drugs at a discount under 42 U.S.C. 256b. Note: 735.530 to 735.552 were added to and made a part of the Insurance Code by legislative action but were not added to ORS chapter 735 or any series therein. See Preface to Oregon Revised Statutes for further explanation.
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