Oregon Revised Statutes Human Services; Juvenile Code; Corrections § 414.372

Current as of January 01, 2023 | Updated by Findlaw Staff

(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;

(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;

(D) Is a patient in a hospital or other medical institution or a resident in a long term care facility.

(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.

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Cite this article: FindLaw.com - Oregon Revised Statutes Human Services; Juvenile Code; Corrections § 414.372 - last updated January 01, 2023 | https://codes.findlaw.com/or/title-34-human-services-juvenile-code-corrections/or-rev-st-sect-414-372/

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