A PBM may not place a drug on a list unless there are at least two therapeutically equivalent, multiple source drugs, or at least one generic drug available from only one manufacturer, generally available for purchase by network pharmacies from national or regional wholesalers. A PBM must update each list maintained by the PBM every 7 business days and make the updated lists, including all changes in the price of drugs, available to network pharmacies in a readily accessible and usable format. A PBM must establish a process by which a network pharmacy may appeal its reimbursement for a drug subject to MAC pricing. If the appeal is denied, the PBM must provide the reason for the denial and the national drug code of a drug that may be purchased by similarly situated pharmacies at a price that is equal to or less than the MAC.

Link to Existing Law: OR ST § 735.534

This type of law is fairly standard for PBM MAC oversight. However, given the appeal can only be made to the PBM, there is opportunity to advocate for a stronger regulatory scheme and oversight of PBM.