P.O.

Box 10841
Eugene, Oregon 97440
p/f: 541.257.8878
info@t1df.org
www.t1df.org

March 12, 2017

Keely L. West
Central Operations Manager
Oregon Health Authority
500 Summer St. NE, E-20
Salem, OR 97301
Oregon

by email to: keely.l.west@state.or.us; OHA.PublicRecords@state.or.us.

RE: Public Record Request for Certain Records/Information from the Oregon Prescription
Drug Program Regarding Drug Pricing (OPDP Drug Pricing Transparency)

Dear Ms. West,

The Type 1 Diabetes Defense Foundation is seeking certain records and information
pertaining to the normal business activities of the Oregon Prescription Drug Program,
Oregon Health Authority.

State Agency

This request for records concerns the Oregon Prescription Drug Program.

OPDP started in 2003 as a discount card program/drug purchasing pool to help increase
access to prescription drugs for uninsured and underinsured Oregonians. Measure 44,
passed in the 2006 general election, gave access to the Oregon Prescription Drug Plan to all
Oregon residents, including Medicare Part D recipients. It has since expanded to become a
multi-faceted program that serves both individuals and group purchasers, including insurers,
coordinated care organizations, and self-insured employers.

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OPDP purchases prescription drugs via the Northwest Prescription Drug Consortium (NPDC),
an interstate joint venture between Oregon and Washington (OPDP & WPDP) established in
2006. The two-state consortium serves over a million people and helped facilitate over $800
million in pharmacy purchasing last year alone. In Oregon, OPDP currently serves 300,000
individual Oregonians and more than 200,000 members of a group health benefit plan.

OPDP is thus generally referred to as a multi-state Pharmaceutical Bulk Purchasing program.

OPDP is also a state-sponsored prescription discount card program administered by Moda
and using Medimpact (PilotRx) as their PBM. Oregon-based Moda Health, previously known
as the ODS Companies, Inc., is the current contractor for the consortium. Since 2007, Moda
has handled all services for the consortium, including network development, claims
processing, benefit administration, all drug management programs, mail order, and more
recently the group purchasing organization programs for facilities and eligible employer
groups. MedImpact Healthcare Systems, Inc. handles all claims processing and pharmacy
payment.

OPDP contracts based on basic principles of pass-through pricing. Manufacturer rebates are
passed through at 100%, including rebates on specialty drugs. Neither the Consortium nor
Moda keeps any portion of rebates paid by manufacturers. The full amount of the rebates is
paid or credited directly to the Participating Programs. Participating Programs thus obtain the
lowest net cost for prescription medications. As a result, OPDP accesses, via NPDC, specialty
drugs at a net price that is equivalent to or even at times better than the price negotiated by
commercial insurers. The Consortium’s pass-through rebate arrangements apply to both
traditional and specialty drugs. Rebates and other remuneration are 100% auditable by OPDP
to the National Drug Code (NDC) level.

Similarly, reimbursements to pharmacies are based on actual ingredient costs and fixed
dispensing fees, plus a pre-negotiated fixed “access fee” paid by the pharmacy to Moda
amounting to a few cents per transaction for system access. Reliance on actual costs and fixed
fees eliminates the use of benchmark prices and related issues such as spread pricing.

The Oregon Prescription Drug Program and its agents are in the business of managing a
prescription drug benefit program. Negotiating manufacturer rebates, monitoring
prescription patterns, collecting payments, centralizing transaction data and maintaining
adequate records regarding the disbursement of prescription drugs are usual corporate
functions of this type of organization. Pharmacy Benefit Managers (PBMs) and prescription
drug benefit administrators collect, aggregate and report on prescription drug acquisition
costs, manufacturer rebates, net and list prices, claims expense and usage (including

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prescription volumes) by client type and dispensing location during the normal course of
their business.

Drugs Subject to This Request:

10 individual drugs:

1. Six (6) Analog Insulin Drugs

1.1. Glucagen 1mg Vial / Glucagen Emergency Kit 1mg (Glucagon, Human
Recombinant)
1.2. Glucagon Emergency Kit 1mg Kit (Glucagon Human Recombinant)
1.3.Humalog 100/ml Vial (Insulin Lispro)
1.4.Levemir 100/ml Vial (Insulin Detemir)
1.5.Novolog 100/ml Vial (Insulin Aspart)
1.6.Lantus 100/ml Vial (Insulin Glargine, Hum.Rec.Anlog)

2. One (1) Human Insulin Drug

2.1.Humulin N 100/ml Vial (Insulin NPH Human Isophane)

3. Three (3) Opioid Drugs

3.1.Oxycontin 80mg Tab ER 12H (Oxycodone HCL)

3.2.Oxycodone HCL ER 80mg Tab ER 12H (Oxycodone HCL)
3.3.Hydrocodone-Acetaminophen 10mg-325mg Tablet (Hydrocodone/
Acetaminophen)

12 controlled prescription drug categories:

The 12 controlled prescription drug categories subject to this request are the 12 drug
categories listed in the quarterly Prescription Drug Monitoring by PDMP Research Analyst,
pdmp.research@state.or.us available at http://www.orpdmp.com/quarterly-reports.html

1. Hydrocodone
2. Oxycodone
3. Tramadol
4. Lorazepam
5. Zolpidem

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 6. Amphetamine
7. Alprazolam
8. Clonazepam
9. Methylphenidate
10. Pseudoephedrine
11. Morphine
12. Diazepam

Requested Information/Records

10 individual drugs:

A. For each of the above 10 individual drugs the amount of gross sales (claims expense) in
Oregon, by County, by drug and by general class of recipient (local government, private
sector businesses, labor organizations, and individuals) for the years 2017, 2016, 2015,
2014, and 2013.

B. For each of the above 10 individual drugs the amount of net sales revenue (claims
expense minus manufacturer rebates) in Oregon, by County, by drug and by general class
of recipient (local government, private sector businesses, labor organizations, and
individuals) for the years 2017, 2016, 2015, 2014, and 2013.

C. For each the above 10 individual drugs, the total amount of units sold in Oregon, by
County, by drug and by general class of recipient (local government, private sector
businesses, labor organizations, and individuals) for the years 2017, 2016, 2015, 2014,
and 2013.

D. For each of the above 10 individual drugs, the “Guaranteed effective rate” for the years
2017, 2016, 2015, 2014, and 2013.

E. For all the above six (6) Analog Insulin Drugs (included in the list of 10 individual drugs),
the average manufacturer rebates received and passed through by NPDC to OPDP (as a
% of the Oregon Average Actual Acquisition Cost) for the years 2017, 2016, 2015, 2014,
and 2013.

F. For all the above six (6) Analog Insulin Drugs (included in the list of 10 individual drugs),
the average “Guaranteed effective rates” for the years 2017, 2016, 2015, 2014, and 2013.

Page 4 of 7
G. For the above one (1) Human Insulin Drug (included in the list of 10 individual drugs), the
average manufacturer rebates received and passed through by NPDC to OPDP (as a % of
the Oregon Average Actual Acquisition Cost) for the years 2017, 2016, 2015, 2014, and
2013.

H. For the above one (1) Human Insulin Drug (included in the list of 10 individual drugs), the
average “Guaranteed effective rates” for the years 2017, 2016, 2015, 2014, and 2013.

I. For all the above three (3) Opioid Drugs (included in the list of 10 individual drugs), the
average manufacturer rebates received and passed through by NPDC to OPDP (as a % of
the Oregon Average Actual Acquisition Cost) for the years 2017, 2016, 2015, 2014, and
2013.

J. For all the above three (3) Opioid Drugs (included in the list of 10 individual drugs), the
average “Guaranteed effective rates” for the years 2017, 2016, 2015, 2014, and 2013.

12 controlled prescription drug categories:

K. For the 12 controlled prescription drugs listed in the Prescription Drug Monitoring, the
amount of gross sales revenue (claims expense) in Oregon, by County, by drug and by
general class of recipient (local government, private sector businesses, labor
organizations, and individuals) for the years 2017, 2016, 2015, 2014, and 2013.

L. For the 12 controlled prescription drugs listed in the Prescription Drug Monitoring, the
amount of net sales revenue (claims expense minus manufacturer rebates) in Oregon, by
County, by drug and by general class of recipient (local government, private sector
businesses, labor organizations, and individuals) for the years 2017, 2016, 2015, 2014,
and 2013.

M. For the 12 controlled prescription drugs listed in the Prescription Drug Monitoring, the
total number of units sold in Oregon, by County, by drug and by general class of recipient
(local government, private sector businesses, labor organizations, and individuals) for the
years 2017, 2016, 2015, 2014, and 2013.

N. For the 12 controlled prescription drugs listed in the Prescription Drug Monitoring, the
average manufacturer rebates received and passed through by NPDC to OPDP (as a % of
the Oregon Average Actual Acquisition Cost) for the years 2017, 2016, 2015, 2014, and
2013.

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O. For the 12 controlled prescription drugs listed in the Prescription Drug Monitoring, the
the average “Guaranteed effective rates” for the years 2017, 2016, 2015, 2014, and 2013.

P. For all prescription drugs listed in the Prescription Drug Monitoring, the average
manufacturer rebates received and passed through by NPDC to OPDP (as a % of the
Oregon Average Actual Acquisition Cost) for the years 2017, 2016, 2015, 2014, and 2013.

OPDP corporate documents:

Q. Moda’s master consortium contracts, which define the terms, performance expectations
and guarantees in effect during the years 2017, 2016, 2015, 2014, and 2013.

R. Medimpact’s PBM contracts in effect during the years 2017, 2016, 2015, 2014, and 2013.

S. Manufacturers’ rebate pass-through agreements with Moda and Medimpact in effect

during the years 2017, 2016, 2015, 2014, and 2013.

T. OPDP’s audit reports concerning Moda’s and Medimpact’s performance during the years
2017, 2016, 2015, 2014, and 2013.

Request for Fee Waiver

T1DF is an Oregon non-profit 501(c)(3) corporation (IRS Determination Letter No.

26053438001837, February 10, 2017, attached). We therefore request that costs of $50 or
less be waived and that costs in excess of $50 be also waived in their entirety (or, in the
alternative, halved) in accordance with ORS 192.440(5), OAR 943-003-0000 and the OHA fee
and waiver policy as such a waiver would be in the public interest.1

The requested records or documents are within the normal scope of OHA business and
should be readily available without undue burden or processing time.

T1DF is a very small organization with an annual operating budget of less than $15,000,
including donated services. Requiring payment would cause us extreme financial hardship.

1 T1DF could not complete form HS 5108 (Request for waiver of public record request fee), as instructed by Item
No. 7 of Policy Number: OHA-010-010-01 (Public Records Request Fees and Waivers), as a search for this form on
the OHA website did not return any positive result. No request for waiver form could be found at: http://
www.oregon.gov/oha/ERD/Pages/Records.aspx

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The requested material concerns the price of drugs in Oregon and is sought for research and
education purposes. As demonstrated by the overwhelming support received by HB 4005,
drug pricing transparency is a key concern for Oregonians and a matter of great public
interest. As stated in the preamble of HB 4005:

“[T]he state has a substantial public interest in the price and cost of prescription
drugs… [D]isclosure of information relating to the cost and pricing of prescription
drugs [provides] accountability for prescription drug pricing.”

In the spirit of drug pricing transparency bill HB 4005, recently signed by Governor Brown,
T1DF thus endeavors to advance further drug pricing transparency from public entities acting
in a drug purchasing capacity. Further drug pricing disclosure will educate the general public
and will provide a transparency and price lowering benchmark against which HB 4005
performance and the drug manufacturers’ transparency endeavors can be measured.

T1DF’s request is related to its public education mission as it pertains to the price of
prescription drugs in Oregon. It is not related to any discovery requests made as part of
pending administrative, judicial, or arbitration proceedings in or outside Oregon.

Thank you for your consideration of this request.

Respectfully submitted,

Charles Fournier
Vice President
Type 1 Diabetes Defense Foundation

Attachments:

- IRS 501(c)(3) determination letter dated February 10, 2017.

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 From: Charles Fournier charles.fournier@t1df.org
Subject: Public Record Request for Certain Records/Information from OPDP/OHA Regarding Drug Pricing
Date: March 13, 2018 at 8:42 PM
To: OHA.PublicRecords@state.or.us
Cc: Boss Julia julia.boss@t1df.org, keely.l.west@state.or.us

Dear Ms. West,

The Type 1 Diabetes Defense Foundation is seeking certain drug pricing records and information pertaining to the normal
business activities of the Oregon Prescription Drug Program (Oregon Health Authority). Our detailed request is attached.

Due to its length, I decided to email it instead of using the online form available on the OHA website. Please also note that I could
not find Form HS 5108 (Request for waiver of public record request fee), as instructed by Item No. 7 of Policy Number: OHA-010-
010-01 (Public Records Request Fees and Waivers). If this form is necessary to request a full waiver, would you please forward it to
me.

Thank you for your attention to this matter. I look forward to hearing back from your office regarding this request.

Regards,
Charles Fournier

Charles Fournier, J.D.

Vice President
Type 1 Diabetes Defense Foundation
Charles.Fournier@t1df.org
(206) 643-1479

@t1df_advocacy
https://twitter.com/t1df_advocacy
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www.t1df.org

T1DF - Request
Drug P…-13.pdf