Starting in 2024, Oregon law requires pharmacy benefit managers (PBMs) to report information to the Drug Price Transparency (DPT) Program each year (ORS 735.537 and
OAR 836-200-0418). PBMs are required to provide the following by June 1 for the preceding calendar year:
- Total amount of rebates, fees, price protection payments, and any other payments the PBM received from manufacturers related to managing benefits for insurers issuing health benefit plans in Oregon.
- The total amount must include all payments the PBM received from manufacturers directly and any payments received from manufacturers by the PBM's subsidiaries, any other entities that the PBM holds an ownership in, or any entities that hold an ownership interest in the PBM.
- Amount of total passed to insurers issuing health benefit plans in Oregon.
- Amount of total passed to enrollees of health benefit plans in Oregon.
- Amount of total retained by the PBM, including the PBM’s subsidiaries, any other entities that the PBM holds an ownership in, or any entities that hold an ownership interest in the PBM, as revenue.
We do not receive reports on any other income received by PBMs, such as fees from insurers, fees from pharmacies, income from PBM-owned pharmacies, network fees, etc. We also do not receive information on the number of covered lives in Oregon for these PBMs.
Note that the PBM information reported to Oregon does not include PBM information related to federal and military health plans, Medicare, Public Employees' Benefit Board (PEBB), Oregon Educators Benefit Board (OEBB), self-insured health plans, Medicaid coordinated care organizations, and other plans not considered “health benefit plans."
In 2024, the program received 2023 data from the following 18 PBMs:
- A & A Drug Co. dba Sav-Rx Prescription Services
- AffirmedRx PBC
- Capital Rx, Inc.
- CaremarkPCS Health, L.L.C.
- Cigna Health and Life Insurance Company
- Cigna Health and Life Insurance Company for TPM (Timber Products Manufacturers) Trust
- Drexi Inc.
- Express Scripts Administrators, LLC
- FairScript, LLC
- Magellan Rx Management, LLC
- Mark Cuban Cost Plus Benefits LLC
- MedImpact Healthcare Systems, Inc.
- Mitchell International, Inc.
- Navitus Health Solutions, LLC
- OptumRx, Inc.
- Prescryptive Health, Inc.
- Prime Therapeutics LLC
- True Rx Management Services, Inc.
The following table is the aggregate payments reported by all 18 PBMs:
| Rebates and payments from manufacturers | Amount passed to insurers | Amount passed to enrollees | Amount retained as revenue |
|---|
| $287,583,732.64 | $283,727,097.34 | $2,236,217.76 | $1,620,417.55 |
Of the 18 PBMs, nine reported zero amounts retained, indicating that they pass all manufacturer payments through to insurers or enrollees. The nine who reported zero may not have included amounts retained as revenue by their related entities.