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).
|Nprm-121-0040-10152015||Notice 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: email@example.com
|120-148-changes-10012015||Permanent Rule Filing|
410-120 to 410-148
Update International Classification of Diseases Coding from ICD-9 to ICD-10
|410-121-0030-10012015||Temporary Rule Filing|
410-121-0030 Amending PDL March 26, May 28, 2015 DUR/P&T Action.
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.
Billing diabetic supplies
Oregon Medicaid PA Criteria
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.
Supplemental rebate information
Request to Change Pharmacy - For Pharmacy Management Program clients
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
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
Who to call for help