Resources for Prescribers and Pharmacies

Oregon Administrative Rules

For current and recent rulemaking, visit the OHP Rulemaking page.

Announcements

Average Actual Acquisition Cost (AAAC) Rates

Average Actual Acquisition Cost (AAAC) is the average of all rates collected in acquisition cost surveys by Myers & Stauffer, LC.

Rates are based on the actual cost (invoice) to the pharmacy for the drug dispensed plus dispensing fee based on claim volume. Myers & Stauffer, LC conducts annual surveys to determine each pharmacy's claim volume.
To respond to changes in the pharmaceutical market that may affect drug pricing or availability, Myers & Stauffer adjusts AAAC rates weekly.

Weekly AAAC rates for brand and generic drugs (scroll down to "AAAC Archive"). These rates are informational only. Inclusion of a drug in the AAAC rate list does not guarantee coverage.

If your pharmacy would like a non-disclosure agreement (NDA) with OHA for information shared through the pricing and volume surveys conducted by Myers & Stauffer, LC:

Contact OHP Pharmacy Program (fax 503-947-1119).
The agreement will be executed and returned to you as soon as possible.

You can also view a copy of the state's NDA with Myers & Stauffer.

Drug Coverage

Visit the OHP Preferred Drug List page (www.orpdl.org) for:

Preferred Drug List: The most cost-effective drugs for fee-for-service prescriptions
High-Cost Drug Carve-Out List: High-cost drugs and biological products OHA covers for all Oregon Health Plan members
Preferred Diabetic Supplies: Preferred continuous glucose monitors and other diabetic supplies
Over-the-Counter (OTC) List: The OTC products OHA covers for all OHP members

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.

Carve Out Drug List, 1st Quarter 2025 (3/31/2025)
Carve Out Drug List, 4th Qtr 2024 (12/31/2024)
Carve Out Drug List, 3rd Quarter 2024 (9/30/2024)
Carve Out Drug List, 2nd Quarter 2024 (6/30/2024)
Carve Out Drug, List, 1st Quarter 2024 (3/31/2024)

The searchable Preferred Drug List also lists current drug use criteria for each drug that require prior authorization.

Oregon Health Authority updates Oregon Medicaid PA Criteria to align with recommendations from the Pharmacy and Therapeutics Committee (formerly Oregon DUR Board). View recent criteria:

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

Monthly Prescription Drug Plan Formulary and Pharmacy Network Information: Information on Part D formulary and pharmacy networks for Medicare Prescription Drug Plans and Medicare Advantage Plans.

Resources for Prescribers

CAREAssist program page

See Oregon Administrative Rule 333-022-1000

Oregon Prescription Drug Monitoring Program

See the program's Oregon Administrative Rules (Chapter 333, Division 23)

OHP 3978 - Prior Authorization Request Form

The searchable Preferred Drug List has current drug use criteria for drugs that require prior authorization.

To find whether a drug requires prior authorization, you can also use the Benefits and HSC List Inquiry or Drug Search in the MMIS Provider Portal at https://www.or-medicaid.gov.

Also see Oregon Administrative Rule 410-121-0040 and the Pharmaceutical Services Provider Guide.