Investor Presentaiton

pricing poses risks, there are other transactions outside of the claims payment process possibly affecting costs at the pharmacy level and PBM revenues. There are additional fees PBMs can receive from insurers, pharmacies, and drug manufacturers that are considered proprietary information, which makes it even more challenging for Medicaid programs to truly understand the actual cost of pharmacy benefits. Medicaid, the largest and most complex government program in Oregon, uses PBMs for most pharmacy benefits Across the nation, Medicaid programs and public employee health plans are evaluating their relationships with PBMs due to concerns about the complexity of the process, transparency, and rising costs. Medicaid is a government program providing health care coverage to low-income adults, children, pregnant people, the elderly, and people with disabilities. It is financed through federal and state funding and is administered by each state. Figure 4: Oregon spends more on Medicaid than any other program Human services Public safety 10% 5% FEDERALRESERVENDTE THE UNITED STATES OF AMERICA THIS NOTE IS LEGAL ENDER FOR ALL DEBTS, PUBLIC AND PRIVATE B0354275 F Ba 2 B B 03542754 2 for Sumatestas die Treasurer of the United States patas avatava Medicaid 32% WASHINGTON, D. 0. TENT 2 20 39 Secretary of the Trees y ONE DOL Education 19% Other 15% Unemployment 13% B95 Transportation 5% Source: Auditor-created based on the State of Oregon 2020 Financial Condition Report In 2020, Oregon spent more on the Medicaid program than it did on any other area, including education, transportation, and public safety combined. 4 As of January 2023, about 1.4 million people in Oregon receive Medicaid benefits. In 27 counties in Oregon, more than one-third of the population receives Medicaid benefits. The federal government estimates national Medicaid expenditures will increase to over $1 trillion by 2028; state officials estimate the cost of health care in Oregon will grow faster than the state's 4 State of Oregon 2020 Financial Condition Report Oregon Secretary of State Report 2023-25 | August 2023 | page 5

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