Prescription Drug Affordability Board Activity through February 25, 2025

Click the image for bill summaries and links to legislature pages.

PBMs are an important part of the Oregon legislative slate this year. HB 3226 requires pharmacy services administrative organizations (PSAOs) to be licensed with the PDAB and there is a drug transparency bill that will impact the PDAB.

HB 3613 would put Oregon’s prescription drug program into a single entity that could coordinate its activities, related to board recommendations.

There are also a large number of bills related to the application of the corporate activity tax (CAT ).

The first chamber work session deadline is in early April.

11 comments were reviewed by the board and posted to the website. There were six requests to speak in person.

Lorren Sandt, Caring Ambassadors Program had a question  and a comment regarding patient information requests [on page 50 of the meeting packet]: “Are there therapeutic alternatives1 (for example, a different therapeutic agent) for this drug?”

"This is not intelligible to patients. Not requiring confidentiality means that people won’t answer it. What are you doing for to ensure that you’re going to [get a] wide [variety of] answers. Will you include what the patients have to say in the final executive summary, or will you bury it in a table?"

Tiffany Westrich-Robertson, Patient Inclusion Council, AIA Arthritis and other groups commented that most patients would say that there are not therapeutic alternatives to their care. Some questions are too technical for patients (i.e. difference between dosage and strength). She submitted a lengthy letter covering these topics in detail.

Scott Bertrani, Health HIV said that 340B needs to be included to ensure that HIV patients and orphan drug patients are treated sufficiently.

Dharia McGrew, PhRMA will be submitting a letter after this month's meeting. She was concerned that the Stakeholder RFI forms do not require confidentiality, and the PDAB should keep confidentiality. She said that stakeholders will not provide information if it isn't kept confidential and the PDAB’s use of the information is not explained up front. Clear definitions and explanation of methodology are needed.

Marty Carty, Oregon Primary Care Association expressed concern that the material submitted in the RFI is subject to public display. The information could lead to unfair contracting practices with payers or manufacturers. Questions 6 and 11 caused the most concern.  All covered entities in the state should be subject to the RFI. The board should take a larger view of covered entities that use 340B savings.

The conflict-of-interest policy is on page 15 of the board document package. The Department of Justice suggested adding a conflict-of-interest policy in Policy Number 1 in addition to “Policy Number 3, Conflict of Interest.”

New language was reviewed: "When a board member abstains from voting on any matter or section under consideration, the declaration of abstention may include a brief explanation such as a potential conflict of interest or other relevant reason, to ensure transparency and to maintain trust in the decision-making process."

The intention is that the board should disclose conflicts of interest as soon as possible, either at the beginning of a discussion or as soon as a conflict is identified.

The board voted unanimously to approve the policy in Policy 1.

The board voted unanimously to approve the policy in Policy 3 and the conflict-of-interest form.

Legislation requires that the PDAB annually conduct a study of the operation of the U.S. market for generic drugs, both drugs dispensed by pharmacists and drugs administered by physicians, including:

1. the prices of generic drugs on a year-to-year basis,
2. the degree to which generic drug prices affect insurance premiums,
3. annual changes in health insurance cost-sharing for generic drugs,
4. the potential for and history of generic drug shortages,
5. the degree to which generic drug prices affect annual spending in the state medical assistance program, and
6. any other topic the board considers relevant to the cost of generic drugs.

Additional topics the board could consider under "f" above:

• Mergers in the generic market: Review whether competition is robust enough to keep drug costs low and accessible. Ensure merged entities are not prioritizing profits over patient access and utilization.
• Generic drug makers exiting the market: The departure of generic drug makers reducing market competition, potentially resulting in higher costs and limited options for patient access to necessary treatments.
• Tariffs impacting drug importation: Higher tariffs may raise drug prices and limit access for low- and fixed-income individuals.
• Price fixing: Drug price fixing impacts market competition, artificially inflates prices, manipulates access to generic drug availability, and may create higher costs for patients and the healthcare system.
• Cost savings for biosimilars: Biosimilars aim to provide more affordable alternatives to expensive branded drugs.
• Shortages: Drug shortages can disrupt access and necessary patient treatments.
• PBM practices: Review PBM practices regarding generic drug formulary placement.
• International pricing: Compare international prices of brand drugs to U.S. generic drugs.

The board is interested in most of these topics. The report must be completed in six weeks, as the draft is due in April and the final due in May. The legislature adjourns in the middle of June. This limits the board’s ability to influence the legislature beyond that date for the year.

The board is most interested in PBMs, tariffs, and international pricing.

[These documents are available in the board document package.]

Affordability review RFI

• Board question: Is the lack of confidentiality part of statute?
  Answer: Because of aggregation, it did not seem to be vulnerable. However, the staff is talking to DOJ about addressing this issue.
• Board question: The NDC code is required for the forms. Is a separate NDC required for each formulation of a drug?
  Answer: NDC is required to ensure they're capturing the correct drug name.

The RFI will be formalized in March and then sent to the responders in April, for completion in May.

Carrier Data

The board chose to table the discussion of the carrier template after its executive session.

Selection of prescription drugs for affordability review. OAR 925-200-0010

The board doesn’t have upper payment limit authority but is required to develop a plan for implementing UPLS. Looking through the public spreadsheets, the board is trying to figure out how to reduce the potential list of drugs for UPLs. One possibility would be to remove drugs being looked at by the federal government.  The board members suggested considering the highest total annual net of rebate spend per enrollee (cancer [ antineoplastics] and hematological drugs).  The board discussed whether to include generics and orphan drugs, whether to sort by frequency of prescription, or if there is no therapeutic alternative option. These were discussed without conclusion until the meeting was adjourned.