Investor Presentaiton
National Drug Code (NDC)
Oregon Prescription Drug Program
Pass-through contract
The unique three segment number assigned to each drug subject to
commercial distribution and which is used and serves as a universal product
identifier.
Established in 2007, the purpose of the program is to purchase prescription
drugs or reimburse pharmacies for prescription drugs to receive discounted
prices and rebates, make prescription drugs available at the lowest possible
cost to participants in the program and to maintain a list of prescription drugs
recommended as the most effective prescription drugs available at the best
possible prices.
The PBM passes through the amount charged by the pharmacy to the health
insurer. Typically, PBMS will charge a per claim administrative fee in this type of
contract.
Patient steering
Pharmacy auditing
Pharmacy benefit manager (PBM)
Pharmacy collective groups
Pharmacy network
Preferred drug list
Reverse auction
Specialty drug
Some PBMS require contracted health plan beneficiaries to visit affiliated
pharmacies, or pharmacies in which they have an ownership interest including
retail, mail-order, or specialty.
Audits of pharmacies by PBMs to detect fraud, waste, and abuse.
PBM clients are health plans. PBMs handle some or all the pharmacy benefit for
health plans (formulary design, cost sharing and tiers, pharmacist networks
and contracts, price concession negotiation with manufacturers). PBMs may
own mail order pharmacies and/or specialty pharmacies. Unless the PBM owns
a pharmacy, it is not part of the drug distribution/supply chain.
This term refers to either Group Purchasing Organization or Pharmacy Services
Administration Organizations.
A pharmacy network is a list of pharmacies or pharmacists that a health plan or
PBM has contracts with to provide prescription drug services to its members.
A list of prescription drugs that are identified by a contractor's Pharmacy and
Therapeutics Committee as the preferred drugs for prescriptions within a
therapeutic drug class.
An online, competitive bidding process states can use to select a PBM to
manage prescription drug benefits. An auction starts with an opening bid and
PBMS submit lower counteroffers during multiple rounds of bidding. States can
achieve savings by requiring PBMs to offer the same contract terms but at a
lower price than their competitors.
A drug that is costly, requires special supply chain features (such as freezing or
cold storage), typically indicated for a small group of patients, and where the
patients may need special case management services. This is the broadest
definition. There is no single agreed-upon definition, so sometimes specialty
drug will only mean high-cost. For instance, specialty drugs in the Medicare
Part D program are only defined by cost.
Oregon Secretary of State | Report 2023-25 | August 2023 | page 38View entire presentation