Comments to Oregon PDAB on PBM reform, transparency, and increasing prescription drug access
350 Winter Street NE
Salem, OR 97309-0405
pdab@dcbs.oregon.gov
Re: Public Comment for November 19, 2025 Board Meeting
Dear Members of the Oregon Prescription Drug Affordability Board:
The HIV+Hepatitis Policy Institute appreciates the opportunity to comment on the Board’s updated legislative recommendations. As a national patient advocacy organization that works to promote quality and affordable healthcare for individuals living with or at risk of HIV, hepatitis, and other chronic conditions, we see firsthand how PBM practices, pharmacy access, and insurance design determine whether patients can remain on lifesaving treatment. We appreciate the Board’s continued focus on practical, patient-centered reforms that Oregon can move forward with.
We submitted comments on October 9th on the proposed recommendations however, below, we now offer comments aligned to the numbering of the final recommendation options, along with some additional thoughts.
Recommendation 1: PBM Reform and Pricing Transparency
We strongly support Recommendation 1, which provides Oregon with a clear and practical path to improving transparency and accountability within the pharmacy benefit system. PBMs play a major role in determining what patients pay for their medications, yet their pricing, rebate, and contracting practices often remain hidden from policymakers and consumers. Requiring full transparency across commercial plans, including disclosure of spread pricing, rebate retention, and administrative fees, will help the state understand how dollars move through the system and where inefficiencies may be driving higher costs.
We also support efforts to delink PBM compensation from drug prices. Replacing percentage-based or rebate-driven payment models with transparent service fees will realign incentives and reduce the preference for higher-cost drugs. This change would help ensure that clinical value, rather than profit potential, shapes coverage and formulary decisions.
Finally, eliminating spread pricing in Medicaid and managed care is an essential step toward protecting both patients and taxpayers. Spread pricing allows PBMs to keep the difference between what they charge the state and what they reimburse pharmacies. Removing this practice will reduce waste and ensure that public funds are used for patient care rather than middleman markups. Sixteen states have already enacted laws banning or restricting PBM spread pricing, demonstrating bipartisan recognition that this practice drives unnecessary costs.[i]
Recommendation 2: Pharmacy Network Access (Any-Willing-Provider)
Allowing any qualified pharmacy to participate in plan networks is a straightforward and highly impactful tool for improving patient choice and continuity of care. For people living with and at risk of HIV, relationships with trusted pharmacies are essential to maintaining adherence and avoiding treatment interruptions that can lead to resistance, poorer outcomes and in the case of prevention, HIV aquisition. This reform will improve geographic access, prevent pharmacy deserts, and reduce plan-driven disruptions that harm patients.
Recommendation 4(b): Point-of-Sale Rebate Models
Requiring that negotiated manufacturer rebates be passed directly to patients at the pharmacy counter would immediately reduce out-of-pocket costs for Oregonians. Today, most rebates are retained by PBMs and insurers rather than lowering what patients pay at the pharmacy, meaning those with high deductibles or coinsurance rarely see the benefit of these negotiated discounts. Ensuring rebates are applied at the point of sale would deliver real savings to patients, improve medication adherence, and reduce long-term healthcare costs by preventing lapses in treatment. This reform ensures that negotiated savings flow to the people who need them most rather than remaining within the system.
Recommendation 6: 340B Program Transparency
We support the recommendation for a transparent review of how the federal 340B Drug Pricing Program operates within the state, including how program savings are used to support patient care and safety-net providers. The 340B program was created to help low-income and uninsured patients access affordable medications and to enable safety-net providers to expand services that support them. It plays a vital role in sustaining care for patients living with HIV through Ryan White clinics and community health centers, and in HIV prevention. A clearer understanding of how program savings are generated and reinvested would help policymakers assess the program’s economic and public health impact and ensure that benefits reach the intended populations.
Recommendation 8: Future of Oregon’s PDAB
The Board’s openness to reconsidering its structure, whether by dissolving the PDAB or redefining its purpose, reflects a thoughtful and responsible assessment of what will best serve Oregonians. We also want to acknowledge the time and care the Board has put into this work. It was encouraging to hear members at the last meeting speak honestly about the limits of the current list price review approach and the need to think differently about what will truly help patients.
We agree that Oregon may be able to make faster and more meaningful progress through direct legislative action. Many of the most impactful ideas the Board has identified, such as PBM reforms, stronger pharmacy access protections, and efforts that lower patient out-of-pocket costs, can move forward without PDAB price review authority. If the Legislature decides to dissolve the PDAB, Oregon could redirect its energy and resources toward reforms that deliver clearer and more immediate benefits to patients.
If the Board continues in some form, we encourage a more focused mission that zeroes in on the areas where the PDAB can add the most value. A reimagined Board could help improve transparency across the system, support the stability of Oregon’s pharmacy network, and highlight practical strategies that make medications more affordable for patients. This direction would allow the PDAB to contribute meaningfully without taking on a model that has been difficult for other states to implement.
Thank you for the opportunity to comment. If you have any questions or need additional information, please feel free to contact our Government Affairs Manager, Zach Lynkiewicz, at zlynkiewicz@hivhep.org.
Sincerely,
Carl E. Schmid II
Executive Director
[i] MultiState, State PBM Reform: How States Are Trying to Control Pharmaceutical Spending (Jan. 6, 2025)