Recently adopted rules

Amend rules: OAR 836-053-1630, 836-200-0401, 836-200-0406, 836-200-0411, 836-200-0416, 836-200-0418, 836-200-0421, 836-200-0436, 836-200-0440836-053-1630, 836-200-0401, 836-200-0406, 836-200-0411, 836-200-0416, 836-200-0418, 836-200-0421, 836-200-0436, 836-200-0440

Rule summary: This rulemaking replaces references to registration throughout our current rules, encoded at OAR 836-200-0401 et seq with references to licensure. It also adds new data elements to our reporting rule and new market conduct requirements. It also adds language clarifying the bar on retaliation against pharmacies, noting that a pharmacy claims audit may be considered retaliation under certain circumstances. Finally, the rulemaking includes substantial revisions to the language related to pharmacy reimbursement in order to clarify expectations for PBMs when a pharmacy is reimbursed below acquisition cost under a maximum allowable cost schedule.

Filed: 07/29/2025

Effective: 08/01/2025

Documents:
Permanent Administrative Rule

​Hearing Officer's Report

Adopt rules: OAR 836-071-1100, 836-071-1105, 836-071-1110, 836-071-1115, 836-071-1120, 836-071-1125, 836-071-1130, 836-071-1135, 836-071-1140, 836-071-1145, 836-071-1150, 836-071-1155, 836-071-1160, 836-071-1165, 836-071-1170, 836-071-1175, 836-071-1180, 836-071-1185, 836-071-1190, 836-071-1195

Rule summary: By adding/distinguishing a public adjuster license type from an independent adjuster type through rulemaking, the adjuster licensing process will be simplified for both the licensing section of the application, and the applying adjusters. Rulemaking is intended to clarify the roles and responsibilities of each adjuster type, further reduce potential for conflicts of interest, and add better regulatory oversight and consumer protection for distinctly different adjuster disciplines.

Filed: 07/25/2025

Effective: 08/01/2025​

Documents:
Permanent Administrative Rule

Amend: OAR 836-053-0013

Rule summary: Update standard silver plans.

Filed: 06/25/2025

Effective: 07/01/2025

Documents:
Permanent Administrative Rule
Hearing Officer's Report

​Amend: OAR 836-042-0025, 36-042-0045

Rule summary: This rule does not allow for scheduled rating plans, which is in conflict with ORS 656.508(3). Therefore, part (b) of this rule will be removed.

Filed: 06/25/2025

Effective: 07/01/2025

Documents:
Permanent Administrative Rule
Hearing Officer's Report​

​​​​​​​​​Amend: OAR 836-200-0500 to 836-200-0560

Rule summary: ​The purpose of OAR 836-200-0500 to 836-200-0560 is to administer the Oregon Prescription Drug Price Transparency Program established in the Department of Consumer and Business Services for the purposes of providing notice and disclosure of information relating to the cost and pricing of prescription drugs in order to provide accountability for prescription drug pricing. This rule updates statutory references in those rules.

Filed: 03/26/2025

Effective: ​04/01/2025

Documents:
​Permanent Administrative Rule​
Hearing Officer Report​

​​​​​​Amend: OAR 836-150-0040

Rule summary: ​Amended to include payment parameters for plan year 2025 (attachment point of $103,000; reinsurance cap of $1,000,000; and coinsurance rate of 50%), while deleting the provisions related to plan year 2020.

Filed: 1/16/2025

Effective: 1/16/2025

Documents:
​Permanent Administrative Rule​

​​​​Amend rules: OARs 836-200-0401, 836-200-0406, 836-200-0411, 836-200-0416, 836-200-0418, 836-200-0421, 836-200-0436, 836-200-0440

Need for the rule(s): 2024 Oregon House Bill 4149 made updates to the statutes regulating the conduct of pharmacy benefit managers (PBMs). Most significantly, it changed the existing requirement that PBMs register with the Oregon Department of Consumer and Business Services (DCBS) to a licensure requirement. There are extensive references to “registration” in DCBS’s existing rule that will need to be updated to “licensure” language. The law also expanded transparency requirements on PBMs, and new language is needed in the respective rule to reflect the addition of new data elements. Additionally, some stakeholders have raised concerns that PBMs are not in full compliance with existing law. We are proposing updates throughout the PBM rules to provide additional clarity on existing requirements related to “maximum allowable cost” (MAC) lists, and adding new language reflecting market conduct requirements for PBMs that ​were created under 2019 HB 2185 and 2023 HB 2725.

Filed: 12/23/24

Effective: 01/01/2025 through 06/29/2025

Documents:
​Temporary Administrative Rule​

​​​Adopt: OAR 836-053-0441​

Rule summary:

A carrier offering a health benefit plan may not deny or limit coverage under the plan, including, but not limited to denying or limiting coverage of a claim, issuing automatic denials of coverage or imposing additional cost sharing or other limitations or restrictions on coverage for gender-affirming treatment that is: 

• (a) Medically necessary, as determined by the physical or behavioral health care provider who prescribes the treatment; and
• (b) Prescribed in accordance with accepted standards of care.​

Filed: 12/23/2024​

Effective: 01/01/2025

Documents:
​Permanent Administrative Rule​
Hearing Officer’s Report to Agency on Rulemaking Hearing

​​REPEAL: OAR 836-053-0025

Rule summary: Repealing the regulation of the insulin co-pay amount for health benefit plans for the state of Oregon as a result of Senate Bill 1508 (2024).

Filed: 11/26/2024

Effective: 01/01/2025

Documents:
​ Permanent Administrative Rule​

​​​​​Amend: OAR 836-052-1000

Rule summary: Establishes and updates list of prosthetic and orthotic devices; prohibits internal or separate limits or caps on prosthetic and orthotic devices, other than the lifetime policy maximum, when permitted by law; defines when coverage for prosthetic and orthotic device is provided through a managed care organization.

Filed: 11/08/2024

Effective: 01/01/2025

Documents:
​ Permanent Administrative Rule​​

REPEAL: OARs 836-053-1600, 836-053-1605, 836-053-1610

Rule summary: Repealed because the statutory authority for their enactment expired January 2, 2022.​

Filed: 11/08/2024

Effective: 12/01/2024

Documents:
​ Permanent Administrative Rule​​