ORS 743A.062
Prescription drugs


(1)

As used in this section, “medical assistance program” means the state program that provides medical assistance as defined in ORS 414.025 (Definitions for ORS chapters 411, 413 and 414).

(2)

An insurance policy or contract providing coverage for a prescription drug to a resident of this state may not:

(a)

Exclude coverage of the drug for a particular indication solely on the grounds that the indication has not been approved by the United States Food and Drug Administration if the Health Evidence Review Commission established under ORS 414.688 (Commission established) or the Pharmacy and Therapeutics Committee established under ORS 414.353 (Committee established) determines that the drug is recognized as effective for the treatment of that indication:

(A)

In publications that the commission or the committee determines to be equivalent to:
(i)
The American Hospital Formulary Service drug information;
(ii)
“Drug Facts and Comparisons” (Lippincott-Raven Publishers);
(iii)
The United States Pharmacopoeia drug information; or
(iv)
Other publications that have been identified by the United States Secretary of Health and Human Services as authoritative;

(B)

In the majority of relevant peer-reviewed medical literature; or

(C)

By the United States Secretary of Health and Human Services; or

(b)

For an insured who is enrolled in the medical assistance program:

(A)

Except as provided in subsection (3) of this section, require a prescription for the drug to be filled or refilled at a mail order pharmacy; or

(B)

Require a prescription for the drug to be filled or refilled at a pharmacy that is not a local pharmacy enrolled in the medical assistance program.

(3)

Subsection (2)(b)(A) of this section does not prohibit an insurer from requiring a medical assistance recipient to fill or refill a prescription for a specialty drug at a mail order pharmacy that is a specialty pharmacy.

(4)

Required coverage of a prescription drug under this section shall include coverage for medically necessary services associated with the administration of that drug.

(5)

Nothing in this section requires coverage for any prescription drug if the United States Food and Drug Administration has determined use of the drug to be contraindicated.

(6)

Nothing in this section requires coverage for experimental drugs not approved for any indication by the United States Food and Drug Administration.

(7)

This section is exempt from ORS 743A.001 (Automatic repeal of certain statutes on individual and group health insurance). [Formerly 743.697; 2011 c.720 §222; 2021 c.339 §1]

Source: Section 743A.062 — Prescription drugs, https://www.­oregonlegislature.­gov/bills_laws/ors/ors743A.­html.

743A.001
Automatic repeal of certain statutes on individual and group health insurance
743A.010
Services provided by state hospital or state approved program
743A.012
Emergency services
743A.014
Payments for ambulance care and transportation
743A.018
Services provided by osteopathic physician
743A.020
Services provided by acupuncturist
743A.024
Services provided by clinical social worker
743A.028
Services provided by denturist
743A.032
Surgical services provided by dentist
743A.034
Services provided by expanded practice dental hygienist
743A.036
Services provided by licensed nurse practitioner or licensed physician assistant
743A.040
Services provided by optometrist
743A.044
Services provided by physician assistant
743A.048
Services provided by psychologist
743A.051
Services provided by pharmacist
743A.052
Services provided by professional counselor or marriage and family therapist
743A.058
Telemedicine services
743A.060
Definition for ORS 743A.062
743A.062
Prescription drugs
743A.063
Ninety-day supply of prescription drug refills
743A.064
Prescription drugs dispensed at rural health clinics
743A.065
Early refills of prescription eye drops for treatment of glaucoma
743A.066
Contraceptives
743A.067
Reproductive health services
743A.068
Orally administered anticancer medication
743A.069
Insulin
743A.070
Nonprescription enteral formula for home use
743A.078
Newborn nurse home visiting services
743A.080
Pregnancy and childbirth expenses
743A.082
Diabetes management for pregnant women
743A.084
Unmarried women and their children
743A.088
Use by mother of diethylstilbestrol
743A.090
Natural and adopted children
743A.100
Mammograms
743A.104
Pelvic examinations and Pap smear examinations
743A.105
HPV vaccine
743A.108
Physical examination of breast
743A.110
Mastectomy-related services
743A.111
Consumer education about post-mastectomy services
743A.124
Colorectal cancer screenings and laboratory tests
743A.130
Proton beam therapy
743A.140
Bilateral cochlear implants
743A.141
Hearing aids and hearing assistive technology systems
743A.148
Maxillofacial prosthetic services
743A.150
Treatment of craniofacial anomaly
743A.160
Alcoholism treatment
743A.168
Behavioral health treatment
743A.170
Tobacco use cessation programs
743A.175
Traumatic brain injury
743A.180
Tourette Syndrome
743A.185
Telemedical health services for treatment of diabetes
743A.188
Inborn errors of metabolism
743A.190
Children with pervasive developmental disorder
743A.192
Clinical trials
743A.250
Emergency eye care services
743A.252
Child abuse assessments
743A.260
Inmates
743A.262
Preventive health services
743A.264
Disease outbreaks, epidemics and conditions of public health importance
Green check means up to date. Up to date