Oregon PDAB
PDAB Activities
Claims data show drugs that were approved and filled, but not prescriptions denied through prior authorization, abandoned because of cost, or delayed by repeated step therapy. Those barriers are largely invisible to the review process.
Weak demographic data left health equity more qualitative than measurable, prompting the board to retain a basic rubric while prioritizing rural access and patient-provider input.
OR policy reach is narrower than its insured population: Medicare, Medicaid and self-funded employer plans sit largely outside state insurance regulation.
Medication-specific Information
Keytruda exposed a central methodological gap: indication-specific oncology drugs require treatment-course, reimbursement and access analysis—not simple class or per-claim comparisons.
Brenzavvy was listed as another drug that could be used instead of Jardiance. Staff noted that few insurance plans in fact cover it. The Board still wanted its price shown to demonstrate that a lower-priced drug exists, even though most insured patients may not be able to access it. That framing shows why price comparison can’t stand in for access analysis: a drug may suggest that lower pricing is possible, but limited formulary coverage can keep that lower price from benefiting patients.
PDAB Data Collection
All Payer All Claims (APAC) database captures Medicaid pharmacy claims. It cannot distinguish claims filled through 340B entities from non-340B claims. This means the Board may treat Medicaid claims as ordinary drug spending without seeing whether 340B revenue supports HIV pharmacy services, navigation, uncompensated care, or other safety-net functions. A policy based on that incomplete picture could reduce resources for covered entities and disrupt access for People with HIV.
HealthHIV’s Input
HealthHIV Testimony asked the Board to keep patient and provider experience central as it refines affordability review. It called for attention to both point-of-care barriers and upstream payment practices, data that show access problems as well as spending, and clear priorities so state budget concerns don’t overshadow real-world patient needs.
Board Patient Engagement
OR’s patient-engagement effort drew fewer than 100 patients and caregivers across all community forums and only 31 online responses. At least one forum reportedly had just one patient, with staff and industry representatives outnumbering participants . The input that did come in pointed mainly to coverage denials, formulary changes, and insurance rules that blocked or disrupted access, giving the Board a clearer signal about access barriers than about drug price alone. The Board acknowledged that patient participation had been limited. Stigma, timing, logistics, and the effort and power differential involved in public speaking on health situations shaped whether people felt able to engage, prompting the Board to discuss fewer online forums and broader community-based outreach.
