Oregon Statutes 414.372 – 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 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:
Terms Used In Oregon Statutes 414.372
- Coordinated care organization: means an organization meeting criteria adopted by the Oregon Health Authority under ORS § 414. See Oregon Statutes 414.025
- Medical assistance: includes any care or services for any individual who is a patient in a medical institution or any care or services for any individual who has attained 65 years of age or is under 22 years of age, and who is a patient in a private or public institution for mental diseases. See Oregon Statutes 414.025
(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. [2015 c.467 § 2]
See note under 414.351.
[1993 c.578 § 13; 2009 c.595 § 306; repealed by 2011 c.720 § 228]
[1993 c.578 § 12; 2009 c.595 § 307; repealed by 2011 c.720 § 228]