(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:\n(A) Uses three or more pharmacies in a six-month period;\n(B) Fills prescriptions from more than one prescriber for the same or comparable medications for the same time period;\n(C) Alters a prescription; or\n(D) Exhibits behaviors or patterns of behavior that the Pharmacy and Therapeutics Committee has identified as indicative of intentional overutilization or misuse.\n(b) This subsection does not apply to a recipient who:\n(A) Is a member of a coordinated care organization;\n(B) Has Medicare drug coverage, in addition to medical assistance, but no other drug coverage;\n(C) Is a child in the custody of the Department of Human Services; or\n(D) Is a patient in a hospital or other medical institution or a resident in a long term care facility.\n(c) The authority shall prescribe by rule:\n(A) stody of the Department of Human Services; or\n(D) Is a patient in a hospital or other medical institution or a resident in a long term care facility.\n(c) The authority shall prescribe by rule:\n(A) Exceptions to the limitation imposed under paragraph (a) of this subsection; and\n(B) The conditions under which a recipient who is restricted under paragraph (a) of this subsection may change to a different pharmacy.\n(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]\nNote:\nSee note under 414.351.
Oregon Legal Code