Oregon § 743A.171 Payment for substance use disorder treatment

Oregon Statutes

§ 743A.171 — Payment for substance use disorder treatment

Oregon § 743A.171

Vol.18

Title 56Insurance

Ch. 743AHealth Insurance: Reimbursement of Claims

This text of Oregon § 743A.171 (Payment for substance use disorder treatment) is published on Counsel Stack Legal Research, covering Oregon primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Or. Rev. Stat. § 743A.171 (2026).

Text

(1)As used in this section:

(a)“Group health insurance” has the meaning given that term in ORS 731.098.

(b)“Health benefit plan” has the meaning given that term in ORS 743B.005.

(c)“Substance use disorder” has the meaning given that term in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.

(d)“Utilization review” has the meaning given that term in ORS 743B.001.

(2)Notwithstanding any provision of ORS 743A.168, an issuer of group health insurance or an individual health benefit plan, other than a health plan that is subject to 42 U.S.C. 18011:

(a)May not impose a requirement for prior authorization or any other form of utilization review for the reimbursement of a covered medication approved by the United

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(1) As used in this section:
(a) “Group health insurance” has the meaning given that term in ORS 731.098.
(b) “Health benefit plan” has the meaning given that term in ORS 743B.005.
(c) “Substance use disorder” has the meaning given that term in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.
(d) “Utilization review” has the meaning given that term in ORS 743B.001.
(2) Notwithstanding any provision of ORS 743A.168, an issuer of group health insurance or an individual health benefit plan, other than a health plan that is subject to 42 U.S.C. 18011:
(a) May not impose a requirement for prior authorization or any other form of utilization review for the reimbursement of a covered medication approved by the United States Food and Drug Administration that is prescribed for the purpose of treating a substance use disorder, including but not limited to opioid addiction and opioid withdrawal.
(b) Shall reimburse the cost of refills of medications described in paragraph (a) of this subsection if dispensed by a licensed health care professional who is legally authorized to dispense such medications.
(3) Subsection (2) of this section applies to any form of buprenorphine, including but not limited to sublingual, tablet or injectable forms.
(4) This section does not prohibit prior authorization or other utilization review for opioids or opiates prescribed for a purpose other than medication-assisted treatment or the treatment of opiate abuse or addiction.
(5) This section does not prohibit utilization review for the purpose of:
(a) Auditing claims for improper payments, fraud or abuse; or
(b) Reasonable periodic redeterminations about the need for continuing care.
(6) Coverage under this section may be subject to the same terms and conditions that apply to other benefits under the plan except for utilization review as provided in subsection (2) of this section.
(7) This section is exempt from ORS 743A.001.