Chapter 743B — Chapter 743B
107 sections in this chapter.
ORS 743B.601 Synchronization of prescription drug refills. (1) As used in this section
2.2K chars
(a) “Health plan” means: (A) A “health benefit plan” as defined in ORS 743B.005; and (B) A self-insured health plan offered by the Oregon Health and Science University. (b) “Synchronization policy” means a procedure for aligning the refill dates of a patient’s prescription drugs …
ORS 743B.602 Step therapy. (1) As used in this section
5.0K chars
(a) “Beneficiary” means an individual receiving health care that is provided or reimbursed by an entity that provides health care coverage. (b) “Health care coverage” includes any of the following that reimburse the cost of prescription drugs: (A) A health benefit plan; (B) An in…
ORS 743B.603 Out-of-pocket maximums, deductibles, copayments, coinsurance and cost-sharing. (1) As used in this section
3.6K chars
(a)(A) “Generic equivalent” means a drug that meets applicable standards of strength, quality and purity according to the United States Pharmacopeia or other nationally recognized compendium and that, compared to a brand name drug: (i) Has an identical amount of the same active c…
ORS 743B.607 Nonopioid prescription drug coverage requirements. (1) As used in this section
1.5K chars
(a) “Clinically appropriate” means supported by nationally recognized compendia, clinical guidelines or generally recognized standards of care. (b) “Compendia” means those resources widely accepted by the medical profession in the efficacious use of drugs. (c) “Health care covera…
ORS 743B.610 Clinician-administered drugs for treatment of cancer. (1) As used in this section
3.7K chars
(a) “Administer” means to directly apply a drug to the body of a patient by injection, inhalation, ingestion or any other means. (b)(A) “Clinician-administered drug” means an outpatient prescription drug that: (i) Cannot reasonably be: (I) Administered by a patient for whom the d…
ORS 743B.800 Risk adjustment procedures; rules. (1) As used in this section, “health benefit plan” means a health benefit plan, as defined in ORS 743B.005, that is offered in the individual or small group market
13.8K chars
(2) The Department of Consumer and Business Services may establish by rule a procedure for adjusting risk between insurers. If a procedure is established: (a) The procedure may include: (A) An assessment imposed on an insurer if the actuarial risk of the enrollees in the insurer’…
ORS 743B.810 Enrollees covered by workers’ compensation. (1) A health benefit plan may not exclude, and shall expedite preauthorizations required for, work-related injuries or occupational diseases if
1.0K chars
(a) The injured worker is covered by workers’ compensation insurance and the health benefit plan; and (b) The injured worker has submitted a workers’ compensation claim for the work-related injury or occupational disease that has not been accepted or denied by the workers’ compen…