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Committee considers bill to let pharmacists bill Oregon Health Plan for PrEP and PEP services
Summary
House Bill 2,942 would require the Oregon Health Authority and coordinated care organizations to reimburse pharmacists and pharmacies for prescribing, dispensing and administering PrEP and PEP for Oregon Health Plan members, aligning reimbursement pathways with private insurers.
The Senate Committee on Health Care held a public hearing May 1 on House Bill 2,942, which would require the Oregon Health Authority and coordinated care organizations to reimburse pharmacists and pharmacies for the prescription, dispensing and administration of pre‑exposure prophylaxis (PrEP) and post‑exposure prophylaxis (PEP) antiretroviral therapies for Oregon Health Plan members.
Representative Travis Nelson, who testified in support, said the 2021 law that allowed pharmacists to prescribe PrEP and PEP left Oregon Health Plan (OHP) patients without the same reimbursement pathway as privately insured patients. “This bill is about access and prevention,” Nelson said, adding that pharmacists legally authorized to provide the care should be paid for it.
Testimony from David Ramos, public policy manager for Cascade AIDS Project, explained that although pharmacists can prescribe and dispense PrEP and PEP, many do not for OHP patients because they cannot enroll as in‑network medical providers and so cannot reliably bill for the clinical services that accompany a prescription. Ramos described the clinical steps a pharmacist must take before dispensing PrEP — risk assessment, ordering and reviewing labs, counseling and dispensing — and said pharmacies are often paid only for the medication, not the clinical work.
Ramos told the committee PrEP is 99 percent effective when taken as prescribed and PEP is about 80 percent effective if begun within 72 hours of exposure; he said preventing a single HIV infection saves roughly $230,000 in lifetime treatment costs. Committee members asked whether the bill would require a directed payment under federal rules; Representative Nelson clarified the intent on the record that the bill would not require CCOs to make a directed payment as defined in 42 CFR 438.6 but would permit pharmacists to bill for services under ORS 689.645 and ORS 689.704 when providing PrEP and PEP.
Several committee members asked about reimbursement levels; sponsors said the bill would allow pharmacists to be reimbursed through medical billing so they could be paid in the same manner as other providers, but that exact rate comparisons were not specified in testimony and staff would follow up to provide numbers.
The committee closed the public hearing on HB 2,942 and scheduled a work session for Tuesday, May 6.
