Pharmacy lock-in program
- • rules
(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 recipients 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 (Committee to advise and make recommendations on drug utilization review standards and interventions), prior to payment for drugs for a patient who has filled prescriptions for more than 15 drugs in the preceding six-month period. [2015 c.467 §2]
Note: See note under 414.351 (Definitions for ORS 414.351 to 414.414).
3 OregonLaws.org assembles these lists by analyzing references between Sections. Each listed item refers back to the current Section in its own text. The result reveals relationships in the code that may not have otherwise been apparent. Currency Information