Investor Presentaiton
Figure 8: CCOS currently contract with six entities who provide pharmacy benefits
CCO
Advanced Health
PBM(s)7
Medimpact
AllCare
Medimpact
Cascade Health Alliance
MedImpact
Columbia Pacific
OptumRx
Eastern Oregon
Navitus (Oregon Prescription Drug
January 2023 enrollment
27,204
61,884
25,520
35,344
71,475
Program)
Health Share
Multiple8
427,339
InterCommunity Health Network
OptumRx
80,126
Jackson Care Connect
OptumRx
62,681
PacificSource- Central
CVS Caremark
73,117
PacificSource- Columbia Gorge
CVS Caremark
16,841
PacificSource- Lane
CVS Caremark
89,098
PacificSource- Marion/Polk
CVS Caremark
140,073
Trillium Community Health-
Southwest
Envolve Pharmacy Solutions
35,874
Trillium Community Health- Tri-
Envolve Pharmacy Solutions
38,381
County
Umpqua Health Alliance
Yamhill Community Care
FFS
Total
Medimpact
Providence
N/A
36,797
34,778
129,230
1,385,762
Source: OHA PBM and Medicaid enrollment information
Pharmacy benefits continue to be a large spending category for CCOS
OHA estimates about 14% of each monthly capitated payment sent to CCOS is for prescription drugs. It
is important to note this estimate does not include drugs given in a hospital setting or drugs
administered by physicians. Mental health drugs are also excluded, as they are paid under the FFS
model, even if the person is enrolled in a CCO.9 In 2021, about 11.8 million Medicaid prescriptions were
dispensed at pharmacies, and CCOs reported spending $767 million on prescription drug benefits, while
FFS drug expenditures were $208 million. 10
Generic drugs are the most prescribed medications, but specialty drugs make up a disproportionate
share of total expenditures. There is no single agreed-upon definition of a specialty drug between PBMs
and insurers. Definitions vary, but can include high-cost medications, drugs that require special
handling, availability limited to certain pharmacies, and drugs that treat rare diseases. Some generic
drugs can cost $2 or less, while some specialty drugs can cost over $100,000 per prescription. Generics
7 Some CCOs have changed PBMs in the past five years. Figure 7 reflects the CCO-PBM relationships as of January 2023.
8 Health Share has multiple subcontractors, each with their own pharmacy benefit relationship. These include OHSU, Providence,
Kaiser, CareOregon, Optum Rx, and Legacy/Pacific Source.
9 Per OAR 410-141-3855, mental health drugs in Standard Therapeutic Classes 7 and 11 are carved out from coordinated care
benefits. Providers bill OHA directly for these medications.
10 The total amount paid does not reflect any rebates received that would reduce the total amount spent. FFS and CCO claims
are both subject to federally mandated rebates.
Oregon Secretary of State Report 2023-25 | August 2023 | page 9View entire presentation