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Pharmaceutical Services program
Oregon Administrative Rules
Chapter 410 Division 121 - Currently on file with Oregon Secretary of State
- See 410-121-0000 through 410-121-0625 for Oregon Medicaid rules
- See 410-121-2000 through 410-121-2065 for Oregon Prescription Drug Program rules
- See 410-121-3000 for CAREAssist rules
- See 410-121-4000 through 410-121-4020 for Oregon Prescription Drug Monitoring Program rules
Recent rule revisions
- 08/13/2014 (T) - 410-121-0040 Amending Prior Authorization Guide - March 27, May 29, July 31, 2014 DUR/P&T Action
- 07/15/2014 (T) - 410-121-0030 PDL March 27, 2014 DUR/P&T Action; 410-121-0040 Prior Authorization Guide – March 27, May 29, 2014 DUR/P&T Action
- 06/30/2014 (P) - 410-121-0030 Amending PDL May 23, July 25, September 26, 2013, and January 30, 2014 DUR/P&T Action and SR Contract Updates; 410-121-0040 Amending Prior Authorization Guide May 23, July 25, September 26, 2013, and January 30, March 27, 2014 DUR/P&T Action
Administrative rulebooks2007-2009 - 2005-2006 - 2003-2004
- 340B entities - 1st Quarter 2014
- Pharmacy Provider Guide - Eligibility and coverage information; billing guidelines for professional and pharmaceutical services, including Medication Therapy Management (MTM); Point of Sale, ProDUR and prior authorization information; 340B program information; contact information; related forms and resources.
- Oregon Medicaid Pharmacy Quick Reference - Telephone numbers, e-mail addresses, Web links, quick facts about billing Oregon Medicaid, and after-hours contact information for managed care prescriptions.
- Billing resources: Allowable National Drug Codes (NDCs) for billing diabetic supplies, NCPDP D.0 Payer Sheet
- 7/11 carve-out list - DMAP pays for covered drugs on this list on a fee-for-service basis for all OHP clients, whether they are in managed care or not.
- Non-covered services: Drugs included in the bundled rate for long-term care nursing facilies,
Less-Than-Effective Drug (or DESI) List drugs
- Actual Average Acquisition Cost (AAAC) Weekly Rate Updates and AAAC rate review forms and processes
- CMS Federal Upper Limits - CMS has published cumulative changes from 2002 through September 25, 2009 on the FUL Web page under "Changes made to Transmittal No. 37."
- 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.
- Oregon Medicaid PA Criteria – Refer to this document for drugs that require PA and how to submit PA requests.
- Oregon Pharmacy and Oral Nutritional Supplement PA Request – Fax to the Oregon Pharmacy Call Center at 888-346-0178.
- Oregon State Drug Review Newsletter and past issues
- OHP Prioritized List of Health Services information
For drug manufacturers
- Oregon Pharmacy and Therapeutics Committee
- Facts about managed care organization drug rebates
- W-9 form for drug rebate reporting - This does not need to be signed by DMAP.
- Medicaid Drug Rebate List Updates – See the State Releases section for updates to the CMS master rebate list. DMAP no longer produces a corresponding full rebate list.
- Supplemental drug rebates: Register on the Sovereign States Drug Consortium (SSDC) Web site to submit offers for PDL consideration (see OAR 410-121-0030). By submitting offers through this Web site, manufacturers agree to abide by all rules and policies set forth by the State of Oregon and the Sovereign States Drug Consortium. Also see the CMS letter of approval and model Supplemental Rebate Agreement.
- OHP enrollment reports - Includes First of Month reports for FCHPs/PCOs/CCOs, DCOs and MHOs/CCOs by county or eligibility category.
Who to call for help