§ 414.372 — Pharmacy lock-in program; rules

Oregon § 414.372

• Jurisdiction: Oregon
• Vol.: 11
• Title 34: Human Services; Juvenile Code; Corrections
• Ch. 414: Medical Assistance

Text

(1)(a) If necessary to avoid overutilization by a recipient of medical assistance, the Oregon Health Authority may restrict, for 18 months or less, the recipient’s pharmacy choices for filling and refilling prescriptions to a mail order pharmacy that contracts with the authority, a retail pharmacy selected by the recipient and a specialty pharmacy selected by the recipient, if the recipient:
(A) Uses three or more pharmacies in a six-month period;
(B) Fills prescriptions from more than one prescriber for the same or comparable medications for the same time period;
(C) Alters a prescription; or
(D) Exhibits behaviors or patterns of behavior that the Pharmacy and Therapeutics Committee has identified as indicative of intentional overutilization or misuse.
(b) This subsection does not apply to a recipient who:
(A) Is a member of a coordinated care organization;
(B) Has Medicare drug coverage, in addition to medical assistance, but no other drug coverage;
(C) Is a child in the custody of the Department of Human Services; or
(D) Is a patient in a hospital or other medical institution or a resident in a long term care facility.
(c) The authority shall prescribe by rule:
(A) Exceptions to the limitation imposed under paragraph (a) of this subsection; and
(B) The conditions under which a recipient who is restricted under paragraph (a) of this subsection may change to a different pharmacy.
(2) The authority may conduct prospective drug utilization review, in accordance with rules adopted under ORS 414.361, prior to payment for drugs for a patient who has filled prescriptions for more than 15 drugs in the preceding six-month period.

Legislative History

2015 c.467 §2