Oregon PDAB approves 2025 report with two policy options to send to legislature

The Oregon Prescription Drug Affordability Board voted unanimously on March 18 to approve the final 2025 drug review report and to transmit it to the Oregon Legislature with two staff‑drafted policy options for lawmakers to consider.

The board debated two policy concepts before voting. Policy option 1 would establish targeted caps on patient cost‑sharing at the point of sale for drugs identified through the PDAB affordability review process; the stated intent is to give patients predictable prescription costs for high‑cost drugs identified by the board. Policy option 2 would require plans and pharmacy benefit managers to apply manufacturer rebates and negotiated discounts at the pharmacy counter so patient coinsurance and deductibles are calculated against a rebate‑adjusted net price rather than the list price.

Courtney Whitlock, senior policy analyst, told the board staff prepared the options as a package for legislators to review and consider, and offered an appendix with implementation guardrails and operational notes. Whitlock said the board’s intent was to limit the policies to drugs identified through PDAB reviews so the measures would target medicines the board found to present affordability problems.

Public commenters split along familiar lines. Daria McGrew, speaking for industry, pressed for transparent, consistently applied selection criteria and asked staff to publish the methodology and data behind a new “orphan‑tier” designation. ‘‘The list was narrowed using established criteria, which by my calculations results in 49 drugs,’’ McGrew said, urging that board choices not reflect ‘‘personal opinions or preferences of individual board members.’’

Patient advocates urged stronger protections at the counter. Lauren Sant, executive director of Caring Ambassadors, said she supported capping out‑of‑pocket costs but cautioned that a statutory cap limited only to PDAB‑identified drugs could miss medicines whose affordability changes over time. She warned that selecting primarily cancer and chronic‑disease medicines could risk access for highly individualized therapies.

Insurer testimony emphasized tradeoffs. Maris Olden of Regence Blue Cross Blue Shield of Oregon said a point‑of‑sale pass‑through would isolate savings to users of rebated drugs and could raise premiums for other members because plans would lose a pooling mechanism that spreads rebate savings across an insured population. ‘‘Point of sale rebates would superficially lower costs for some, increase costs for the majority, and mask the root cause of unaffordability, manufacturer prices,’’ Olden said.

Board votes recorded in the transcript: staff put policy option 1 to a roll call that recorded the motion passing 5–2 (Yes: Hoagland, Lehman, Murray, Hartung, Bailey; No: Kennedy, Koder). The board later approved policy option 2 by a 4–3 roll call (Yes: Hoagland, Koder, Murray, Bailey; No: Kennedy, Lehman, Hartung). After discussing wording and an appendix with additional detail for legislators, the board voted 7–0 to transmit the 2025 report to the legislature with both options and the appendix included.

Courtney Whitlock said staff will post edited report language and the appendix online; she also noted that, if legislators act on either option, implementation details and statutory language could be refined through the legislative process.

Next steps: the board will publish the final report and appendix and continue planning 2026 drug reviews and community forums, while staff will prepare the legislative materials recommended by the board.