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Pharmaceutical Services Program

Pharmaceutical Services Program

Find Oregon Administrative Rules and supplemental information administered by the Division of Medical Assistance Programs.

Recent rule filings

You can sort or filter by document type or effective date. You can also view Pharmaceutical Services Program rules as filed with the Secretary of State (please note that rules filed by the first of the month will not be posted on the Secretary of State website until the middle of the filing month).

File Description
Nprm-121-0040-10152015Notice of Rulemaking Hearing
Amending Prior Authorization Approval Criteria Guide
Rulemaking Hearing: October 15, 2015 at 10:30 a.m. Room 165
Last Opportunity for Public Comment: October 17, 2015 at 5 p.m.
Send Comments to: dmap.rules@state.or.us
120-148-changes-10012015Permanent Rule Filing
410-120 to 410-148
Update International Classification of Diseases Coding from ICD-9 to ICD-10
410-121-0030-10012015Temporary Rule Filing
410-121-0030 Amending PDL March 26, May 28, 2015 DUR/P&T Action.
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Administrative rulebooks

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Supplemental information and guidelines

Also see our frequently asked questions about DMAP prescription coverage and Oregon Medicaid Pharmacy Quick Reference.

For resources provided by the OSU College of Pharmacy's Drug Use Review and Management (DURM) Program, including the Oregon State Drug Review, visit the DURM website.


340B resources​

340B Entities Q4 2013
340B Supplemental Chart
Meeting Minutes - 340B Policy Discussion, 10-20-2014
Policy - 340B CCO Claims File Identification
Policy Notification - Oregon Medicaid 340B Drug Claim File


Provider guides

Pharmacy Billing Instructions
Prior Authorization Handbook
OHP birth control methods and reimbursement
Claim Adjustment Handbook
Pharmaceutical Services Provider Guide, August 2012

Billing diabetic supplies

Diabetic Supply Codes and Fees - Billing Examples, August 2011
National Drug Codes for Diabetic Supplies

Other resources

Drugs included in the bundled rate for long-term care nursing facilities
CMS Fact Sheet - Tamper-Resistant Prescription Pad Law
NCPDP D.0 Payer Sheet

Oregon Medicaid PA Criteria

Oregon Medicaid PA Criteria, October 2015New
Oregon Medicaid PA Criteria, August 2015
Oregon Medicaid PA Criteria, July 2015
Oregon Medicaid PA Criteria, April 2015
Oregon Medicaid PA Criteria, February 2015
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Preferred Drug List

Physical health drugs on this list do not require PA. Access the list using Epocrates Rx ("Oregon Medicaid - open card"), and access formularies for other payers, including OHP health plans. Lists before 2012 are in the administrative rulebooks.

Oregon Medicaid Preferred Drug List - October 1, 2015
Oregon Medicaid Preferred Drug List - July 1, 2015
Oregon Medicaid Preferred Drug List - April 18, 2015
Oregon Medicaid Preferred Drug List - March 1, 2015
Oregon Medicaid Preferred Drug List - January 1, 2015
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Supplemental rebate information

Model Supplemental Rebate Agreement
Federal approval - January 2011
Facts about managed care organization drug rebates
W-9 form for drug rebate reporting

7-11 Drug Carve Out List

7-11 Drug Carveout List, February 2014
7-11 Drug Carveout List, November 2013
7-11 Drug Carveout List, October 2013
7-11 Drug Carveout List, September 2013
7-11 Drug Carveout List, June 2013
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DMAP 390

Request to Change Pharmacy - For Pharmacy Management Program clients​

DMAP 3978
Prior Authorization Request for Pharmacy and Oral Nutritional Supplements

Other pharmacy links

OHA Pharmacy Services

Actual Average Acquisition Cost (AAAC) Weekly Rate Updates and AAAC rate review forms and processes
Pharmacy and Therapeutics Committee

Non-Medicaid programs managed by OHA Pharmacy Services:

Centers for Medicare and Medicaid Services

CMS Federal Upper Limits - CMS has published cumulative changes from 2002 through September 25, 2009 under "Changes made to Transmittal No. 37."
Medicaid Drug Rebate Program data files - Less-Than-Effective (LTE/IRS) drugs have a DESI indicator of 5 or 6.
Medicaid Drug Rebate List Updates

Other links

Sovereign States Drug Consortium (SSDC) website
Medicare Modernization Act (MMA) website
National Provider Identifier look-up - All pharmacy claims should include the NPI of the prescribing provider in the prescriber ID field. ​​​​​​​​​​​​​​​​​​​​​​


Pharmacy program announcements

Filling prescriptions for Oregon Medicaid clients who are not in the Oregon MMIS Point of Sale system11/14/2014
October 2014 PDL and prior authorization criteria updates10/23/2014
Encounter reporting of 340B-eligible drugs dispensed to Oregon Health Plan (OHP) clients10/16/2014

Who to call for help