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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.

Recent rule filings

You can also view all Pharmaceutical Services Program rules as filed with the Secretary of State.

Administrative rulebooks

Each rulebook is an interactive PDF that contains all program rules effective on the "Effective Date" listed for the rulebook.  If you need an older rulebook not listed here, visit the OHP Rulebooks page.

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

If you want to view criteria older than the last five versions, select "Effective Date" to select the PA criteria by effective date.

Preferred Drug List

Physical health drugs on this list do not require PA. Lists before 2012 are in the administrative rulebooks. 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 410-141-3070, 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 rules

Notices of Proposed Rulemaking

OHP Rulebooks

Pharmacy Program Quick Links

Forms

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

Meetings

For pharmacies

340B Program

  
  
  
  
  
  
(More Documents...)

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

  
  
  
  
  
(More Items...)

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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