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Pharmaceutical Services Program

Find Oregon Administrative Rules and supplemental information administered by the Health Systems Division.

 Receive program updates by text or email - Please specify which program(s) you are interested in; otherwise, you will receive updates for all programs.

Current Oregon Administrative Rules

Please refer to the Oregon Secretary of State website. OHA no longer maintains the administrative rulebooks.

  • Click the program name, then click the rule you want to view.
  • The current rule will display. To view previous revisions of the rule, click the revision date(s) at the bottom of the rule page. Revisions are available back to 2017.
  • If you need older revisions, please email Adminrules.Archives@oregon.gov.
  • If you have problems accessing older revisions not available on the SOS website, please email HSD.Rules@dhsoha.state.or.us

Recent rule filings

Supplemental information and guidelines

Also see our frequently asked questions about OHP fee-for-service prescription coverage and Oregon Medicaid Pharmacy Quick Reference (includes current pharmacy benefit manager list).

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.

Provider guides

Oregon Medicaid PA Criteria

Preferred Drug List

Physical health drugs on this list do not require PA. Lists before 2012 are in Oregon Administrative Rule 410-121-0030 (Tables 410-121-0030-1 and 410-121-0030-2). You can also use the Searchable PDL.

Mental Health Drug Carve Out List

OHA updates this list quarterly. It lists all “mental health drugs” as defined in OAR 410-141-3855 that are carved out of CCO pharmacy benefits and are reimbursed directly by OHA on a fee-for-service basis. This list does not determine coverage and is subject to change at any time as new drugs come to market, are discontinued, or in rare instances, are reclassified.

Pharmacy program announcements


Policy Quick Links

Rule and Guidelines by Program

Temporary Rule Filings

Permanent Rule Filings

Notices of Proposed Rulemaking

Pharmacy Program Quick Links

Forms

  • OHP 3166 - Client Agreement to Pay for Pharmacy Services
  • OHP 3978 - Prior Authorization Request

Meetings

For pharmacies

340B Program

  
340B Claims File Instructions and Design
340b Claims Response File Design
340B Entities Q1 2016
340B state policy
340B Supplemental Chart

Billing diabetic supplies

Rates

National Provider Identifier look-up - All pharmacy claims should include the NPI of the prescribing provider in the prescriber ID field.

Medicaid prescription drug coverage - Includes federal upper limits, program releases and pricing information

For prescribers

For manufacturers

Sovereign States Drug Consortium (SSDC) website

Supplemental rebates

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

Who to call for help

Oregon Pharmacy Call Center

 888-202-2126 or  Email: dmap.rxquestions@dhsoha.state.or.us

 Address and telephone contacts

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