Oregon PDAB comments on Rx affordability and transparency

Oregon Prescription Drug Affordability Board
350 Winter Street NE
Salem, OR 97309-0405
pdab@dcbs.oregon.gov

Dear Members of the Oregon Prescription Drug Affordability Board:

The HIV+Hepatitis Policy Institute appreciates the opportunity to comment on the Board’s proposed policy recommendations for the 2025 legislative report. 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 every day how out-of-pocket costs, insurance design, and PBM practices shape whether patients can stay on treatment. We applaud the Board for putting forward pragmatic recommendations that can meaningfully improve access and affordability without restricting coverage or innovation.

Putting Patients First: Direct Affordability and Access Reforms
We strongly support the recommendations that will have a direct and measurable impact on what patients pay for their medications:

• Point-of-sale rebates. 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 help 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.
• Elimination of PBM spread pricing in Medicaid and managed care. Spread pricing allows PBMs to profit from the difference between what they charge the state and what they reimburse pharmacies. Removing this opaque practice will reduce waste and ensure that taxpayer funds are used for patient care, not middleman markups. Sixteen states have already enacted laws banning or restricting PBM spread pricing, demonstrating bipartisan recognition that this practice drives unnecessary costs.[1]
• Delinking PBM compensation from drug prices. Replacing rebate-based or percentage-of-price fees with transparent service fees will realign incentives across the system, discouraging PBMs from favoring high-cost drugs and encouraging a focus on value and patient outcomes.

These measures reflect a balanced approach that will drive savings to patients rather than shifting costs elsewhere in the healthcare system. They will help sustain medication adherence and prevent the downstream medical costs that arise when patients cannot afford their prescriptions.

Increasing Transparency Across the Drug Supply Chain
We commend the Board for advancing proposals that bring greater transparency and accountability to how drugs are priced and reimbursed.

• PBM transparency for commercial plans. Requiring full transparency in PBM operations will help policymakers and patients understand how funds flow through the system, where profits are retained, and how those dollars affect patient costs. PBMs play a significant role in determining what patients ultimately pay for their medications, yet their pricing, rebate, and network contracting practices are often opaque. Enhanced disclosure of spread pricing, rebate retention, and administrative fees would allow Oregon to identify inefficiencies and ensure that negotiated savings are passed through to patients rather than absorbed by intermediaries. This approach aligns with reforms already adopted in several other states seeking to hold PBMs accountable and promote fairer, more affordable access to prescription drugs.
• Audit of the 340B program in Oregon. 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. However, questions have been raised nationally about how 340B savings are tracked, whether all eligible patients are benefiting directly, and how consistently savings are reinvested in patient care. An audit would provide policymakers with objective data on its economic and public health impact, clarify how savings are reinvested in patient services, and identify opportunities to ensure funds reach the intended populations.

Greater visibility across the drug supply chain will allow policymakers to target reforms effectively while preserving programs that already work to expand access and improve outcomes.

Ensuring Fair and Transparent Pharmacy Reimbursement
We also support the Board’s efforts to improve the transparency and fairness of pharmacy reimbursement. Pharmacies are a lifeline for many patients, particularly those managing HIV or chronic conditions who depend on trusted local providers to help navigate adherence and access programs.

• Use of verifiable acquisition cost data. Basing reimbursement on objective, publicly available acquisition cost data rather than proprietary PBM lists will help ensure that pharmacies are paid fairly for dispensing medications. Oregon is well positioned to lead on this issue given its existing average actual acquisition cost data infrastructure.
• Prohibiting below-cost dispensing requirements. Pharmacies should not be forced to dispense medications below their cost to purchase and dispense. This reform will protect independent and rural pharmacies that serve as critical access points for vulnerable populations.
• Any-willing-pharmacy provisions. Allowing any qualified pharmacy to participate in plan networks will expand patient choice, especially in rural areas, and improve continuity of care.

Collectively, these changes will help preserve Oregon’s pharmacy network and prevent closures that can disproportionately affect patients in smaller communities and those with complex health needs.

These recommendations will help ensure that savings flow directly to patients, preserve access to community and safety-net pharmacies, and strengthen programs like 340B that sustain care for vulnerable populations. Oregon’s leadership in advancing practical, patient-focused solutions can serve as a model for other states seeking to balance affordability with access and innovation. Thank you for the opportunity to comment and for your ongoing leadership on behalf of Oregon patients. We look forward to supporting the Board’s work as these recommendations move forward to the legislature.

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

[1] MultiState, State PBM Reform: How States Are Trying to Control Pharmaceutical Spending (Jan. 6, 2025)