Investor Presentaiton

savings, like discounts or rebates, to the CCO. Under this model, administrative fees for each claim paid to the PBM by the CCO are typically higher. When CCOS choose a pay-for-performance contract, the PBM passes through rebates and usually sets a much lower administrative fee; however, the PBM will share a quarterly payout, based on performance, with the CCO. This payout is based on two key factors: negotiating drug discounts from manufacturers worth more than the amount stipulated in the contract and paying a smaller per-claim dispensing fee to pharmacies than the fee stipulated in the contract. Determining rebate pass-through is more complicated in a pay-for-performance model. Auditors examined aggregate rebate data for both contract models. The pass-through contracts were clearer to understand, while pay-for-performance aggregate rebate and discount totals were difficult to determine. By requiring all PBM contracts to be pass-through, OHA could increase transparency for dispensing fees and drug rebates and improve its own ability to review and monitor these contracts. Low or unfair reimbursement rates have been attributed to a decline in local, sole proprietor pharmacies, a critical component of the state's health care system Pharmacies are a critical element of health care and are important in promoting health outcomes, but the number of independent, smaller pharmacies in many parts of Oregon has been dwindling. Closures have been driven in part by low or unfair reimbursement rates, making it difficult for these pharmacies to stay open and retain staff. Some PBMS pay pharmacies about a dollar more for dispensing prescriptions in underserved areas, but this increase likely does not cover operating costs for the pharmacy. Dispensing fees paid to pharmacies under FFS are much higher. Taking legislative action to protect reimbursement rates is a critical step in keeping pharmacies open to the benefit of all Oregonians, not just those on Medicaid. Halmok Murray's "When people truly need help, they come to the most accessible health care professional in their community... we serve over 3,000 square miles as the only local providers. People literally drive hours to get our help; whether it's antibiotics, pain medications following surgery, flu or covid vaccinations, diabetic medications, or professional advice on complex medication situations. The services we provide are real and valuable!" John Murray, Rph, independent pharmacy owner in Heppner, written legislative testimony in support of House Bill 3013 in 2023 Pharmacists are ideally positioned in their respective communities to address gaps in care by collaborating with other health care providers, which can help eliminate health disparities. A 2016 study found as the availability of pharmacies in a given area increased, hospital readmissions for people in Oregon Secretary of State Report 2023-25 | August 2023 | page 18

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