State Tracker Updated June 15, 2026

Oregon: what the PBM reimbursement law requires

Oregon licenses and regulates PBMs, requires pass-through pricing, and gives pharmacies a MAC appeal — including when paid below the net acquisition cost — but it has no across-the-board reimbursement floor.

Status	Partially enacted
Law	HB 4149 (2024) — ORS 735.534 and 735.536
Effective date	January 1, 2025
Reimbursement basis	No across-the-board reimbursement floor. PBMs must be licensed, use pass-through pricing (no spread), meet network-adequacy and any-willing-pharmacy rules, and provide a MAC appeal; a pharmacy may appeal when reimbursement is less than the net amount it paid the supplier. The state medical-assistance (Medicaid) program is excluded from this section.
Professional dispensing fee	Not specified in the commercial statute
Appeal route	At least 60 days after a claim is reimbursed to file; the appeal is completed within 30 calendar days

Oregon’s 2024 PBM law (HB 4149, effective January 1, 2025) licenses PBMs and regulates their pricing without setting a categorical reimbursement floor. PBMs must use pass-through pricing, meet network-adequacy and any-willing-pharmacy requirements, and provide a MAC appeal — with at least 60 days to file and a 30-day resolution window.

The statute does let a pharmacy appeal when it is reimbursed below the net amount it paid its supplier, but that is an appeal mechanism rather than a guaranteed floor on every claim, and Oregon’s Medicaid program is carved out of the section. So Oregon is tracked here as regulated, not floored.

Sources

ORS 735.534 — claim reimbursement / MAC / appeals (codified) Primary source
ORS 735.536 — PBM reimbursement requirements (codified) Primary source

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