HB 3086
Requires the Public Employees' Benefit Board to count payments made by or on behalf of an enrollee for the cost of certain prescription drugs when calculating the enrollee's contribution to an out-of-pocket maximum, deductible, copayment, coinsurance or other required cost-sharing for the drugs.
Jurisdiction
Oregon
Session
2025 Regular Session
Committee
Behavioral Health and Health Care
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Sign in to take actionPublic sentiment
Support
100%
Oppose
0%
- Introduced
- Passed House
- Passed Senate
- To Governor
- Became Law
Bill overview
This bill requires the Public Employees’ Benefit Board (PEBB) to include payments made by or on behalf of enrollees for prescription drugs – such as coupons or third-party payments – when calculating their out-of-pocket costs for those medications. This change will affect how PEBB plans determine an enrollee’s contribution to their plan’s maximum, deductible, or copayments for prescription drugs. The bill takes effect 91 days after the end of the legislative session.
Key provisions
- PEBB must count payments from coupons and third parties toward prescription drug costs.
- This applies to calculations of out-of-pocket maximums, deductibles, copayments, and coinsurance.
- The bill amends Oregon Revised Statutes (ORS) 243.144 to incorporate these requirements.
- The changes will apply to benefit plans issued on or after October 1, 2025.
- The bill references specific Oregon laws related to health benefit plan coverage.
Who is affected
- Public Employees’ Benefit Board (PEBB) employees and their families
- Oregon residents enrolled in PEBB health plans
- Pharmaceutical companies and third-party payment providers
Notable changes
- Previously, PEBB did not account for payments made by third parties towards prescription drug costs.
- This bill expands the calculation of out-of-pocket costs to include these payments.
Sponsors
Official sponsors from legislative records.
Primary sponsors
Emerson Levy
Arguments in favor
Reasons to support this legislation.
Supporters of the legislation argue that high deductibles and out-of-pocket maximums are creating financial burdens for Oregonians, particularly those with expensive specialty medications. They believe that patients should be able to use patient assistance funds towards their deductibles and out-of-pocket maximums, allowing them to better manage these costs. Additionally, advocates contend that copay assistance programs can help reduce the financial burden of medication by applying coupon discounts to insurance cost-sharing requirements, promoting balance in the healthcare system and ensuring that Oregonians have access to affordable care.
Source: Testimony Summaries
Arguments opposed
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