Investor Presentaiton
Figure 17: National and specialty/mail order pharmacies were reimbursed more than independent
pharmacies for most drugs tested
$6.50
$4.50
$2.50
$0.50
($1.50)
($3.50)
Eliquis
Independent
National chain
Acetaminophen Omeprazole
Specialty/mail order
Metformin
Flovent
Amoxicillin
Basaglar
Source: Auditor analysis of OHA and PBM 2021 claims data and National and Oregon Average Acquisition Cost data
Long wait times, low pharmacy density, and unfair pharmacy reimbursements pose access issues for all
people in Oregon, not just Medicaid patients. Oregon's Legislature should enact legislation prioritizing
fair and consistent reimbursement for community pharmacies.
"A little over a month ago our pharmacy got a desperate call from a woman from Madras. It was late
on Friday and her husband had been prescribed... a critical medicine to keep him out of the hospital.
She went to the only chain pharmacy open in town and they told her it would be Monday before
they could fill it. You see, both Bi-Mart and Hometown drugs had closed. Their pharmacy business
was booming but their reimbursements were too low to stay open. The remaining chain pharmacy in
town was so overwhelmed their wait times were measured in days. She called two chain pharmacies
in Redmond and could not get anyone to answer the phone. Again, reimbursements are too low to
keep adequate staffing, even to answer the phone. Then she called us. We told her to come right
away as it was close to closing and when she arrived, we quickly filled the prescription. She had lots
of questions and health care concerns, as she had not been able to speak to a pharmacist since
Hometown drugs had closed. When she left it was 30 minutes after closing and we felt happy that
we had helped someone in need that day. I then checked my reimbursement and found that I got
paid $26 below my acquisition price for that drug. This is not the value of the service we provided
that night. Independent pharmacies, in particular, have an important value to their communities, and
they should be paid fairly for that value."
Kevin Russell, RPh, MBA, BCACP, Director of pharmacy at Prescryptive Health, oral
legislative testimony in support of HB3013 2023 regular session
Other states require PBMs to disclose certain information to better assess their value and
increase transparency
A lack of transparency in PBM processes has led many states to implement laws requiring PBMs to
disclose certain pricing and cost information. Information disclosed includes aggregated data on
Oregon Secretary of State | Report 2023-25 | August 2023 | page 23View entire presentation