Chapter 414 — Chapter 414
341 sections in this chapter.
ORS 414.314 Application and participation in Oregon Prescription Drug Program; prescription drug charges; fees. (1) An individual or entity described in ORS 414.312 (4) may apply to participate in the Oregon Prescription Drug Program. Participants shall apply on an application provided by the Oregon Health Authority. The authority may charge participants a nominal fee to participate in the program. The authority shall issue a prescription drug identification card to participants of the program
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(2) The authority shall provide a mechanism to calculate and transmit the program prices for prescription drugs to a pharmacy. The pharmacy shall charge the participant the program price for a prescription drug. (3) A pharmacy may charge the participant the professional dispensin…
ORS 414.316 [2003 c.714 §3; 2007 c.697 §19; 2009 c.595 §293; repealed by 2015 c.318 §56]
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[Repealed or reserved.]
ORS 414.318 Prescription Drug Purchasing Fund. The Prescription Drug Purchasing Fund is established separate and distinct from the General Fund. The Prescription Drug Purchasing Fund shall consist of moneys appropriated to the fund by the Legislative Assembly and moneys received by the Oregon Health Authority for the purposes established in this section in the form of gifts, grants, bequests, endowments or donations. The moneys in the Prescription Drug Purchasing Fund are continuously appropriated to the authority and shall be used to purchase prescription drugs, reimburse pharmacies for prescription drugs and reimburse the authority for the costs of administering the Oregon Prescription Drug Program, including contracted services costs, computer costs, professional dispensing fees paid to retail pharmacies and other reasonable program costs. Interest earned on the fund shall be credited to the fund. [2003 c.714 §4; 2007 c.697 §20; 2009 c.595 §294]
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Note: See note under 414.312.
ORS 414.320 Rules. The Oregon Health Authority shall adopt rules to implement and administer ORS 414.312 to 414.318. The rules shall include but are not limited to establishing procedures for
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(1) Issuing prescription drug identification cards to individuals and entities that participate in the Oregon Prescription Drug Program; and (2) Enrolling pharmacies in the program. [2003 c.714 §5; 2007 c.697 §21; 2009 c.595 §295] Note: See note under 414.312. (Prescription Drug …
ORS 414.324 Prohibition on requiring prior authorization or step therapy for human immunodeficiency virus drugs. (1) As used in this section
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(a) “Prior authorization” has the meaning given that term in ORS 743B.001. (b) “Step therapy” has the meaning given that term in ORS 743B.001. (2) Notwithstanding ORS 414.325, the Oregon Health Authority and a coordinated care organization may not require prior authorization or s…
ORS 414.325 Prescription drugs; use of legend or generic drugs; prior authorization; rules. (1) As used in this section
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(a) “Legend drug” means any drug requiring a prescription by a practitioner, as defined in ORS 689.005. (b) “Urgent medical condition” means a medical condition that arises suddenly, is not life-threatening and requires prompt treatment to avoid the development of more serious me…
ORS 414.326 Supplemental rebates from pharmaceutical manufacturers. (1) The Oregon Health Authority shall negotiate and enter into agreements with pharmaceutical manufacturers for supplemental rebates that are in addition to the discount required under federal law to participate in the medical assistance program
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(2) The authority may participate in a multistate prescription drug purchasing pool for the purpose of negotiating supplemental rebates. (3) ORS 414.325 and 414.334 apply to prescription drugs purchased for the medical assistance program under this section. [Formerly 414.747; 201…
ORS 414.327 Electronically transmitted prescriptions; rules. The Oregon Health Authority shall adopt rules permitting a practitioner to communicate prescription drug orders by electronic means directly to the dispensing pharmacist. [2001 c.623 §8; 2003 c.14 §192; 2009 c.595 §297]
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Note: 414.327 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
ORS 414.328 Synchronization of prescription drug refills. (1) As used in this section, “synchronization policy” means a procedure for aligning the refill dates of a patient’s prescription drugs so that drugs that are refilled at the same frequency may be refilled concurrently
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(2) Each coordinated care organization shall implement a synchronization policy for the dispensing of prescription drugs to members of the organization. (3) The Oregon Health Authority shall implement a synchronization policy for the dispensing of prescription drugs to recipients…
ORS 414.329 Prescription drug benefits for certain persons who are eligible for Medicare Part D prescription drug coverage; rules. (1) Notwithstanding ORS 414.591, 414.631 and 414.688 to 414.745, the Oregon Health Authority shall adopt rules modifying the prescription drug benefits for persons who are eligible for Medicare Part D prescription drug coverage and who receive prescription drug benefits under the state medical assistance program or Title XIX of the Social Security Act. The rules shall include but need not be limited to
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(a) Identification of the Part D classes of drugs for which federal financial participation is not available and that are not covered classes of drugs; (b) Identification of the Part D classes of drugs for which federal financial participation is not available and that are covere…
ORS 414.330 Legislative findings on prescription drugs. The Legislative Assembly finds that
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(1) The cost of prescription drugs in the medical assistance program is growing and will soon be unsustainable; (2) The benefit of prescription drugs when appropriately used decreases the need for other expensive treatments and improves the health of Oregonians; and (3) Providing…
ORS 414.332 Policy for Practitioner-Managed Prescription Drug Plan. It is the policy of the State of Oregon that a Practitioner-Managed Prescription Drug Plan will ensure that
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(1) Oregonians have access to the most effective prescription drugs appropriate for their clinical conditions; (2) Decisions concerning the clinical effectiveness of prescription drugs are made by licensed health practitioners, are informed by the latest peer-reviewed research an…
ORS 414.334 Practitioner-Managed Prescription Drug Plan for medical assistance program. (1) The Oregon Health Authority shall adopt a Practitioner-Managed Prescription Drug Plan for the medical assistance program. The purpose of the plan is to ensure that enrollees in the medical assistance program receive the most effective prescription drug available at the best possible price
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(2) In adopting the plan, the authority shall consider recommendations of the Pharmacy and Therapeutics Committee. (3) The authority shall consult with representatives of the regulatory boards and associations representing practitioners who are prescribers under the medical assis…
ORS 414.336 [2003 c.810 §22; repealed by 2009 c.827 §14]
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[Repealed or reserved.]
ORS 414.337 Limitation on rules regarding Practitioner-Managed Prescription Drug Plan. The Oregon Health Authority may not adopt or amend any rule that requires a prescribing practitioner to contact the authority to request an exception for a medically appropriate or medically necessary drug that is not listed on the Practitioner-Managed Prescription Drug Plan drug list for that class of drugs adopted under ORS 414.334, unless otherwise authorized by enabling legislation setting forth the requirement for prior authorization. [2009 c.827 §11; 2009 c.827 §12]
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Note: 414.337 was enacted into law by the Legislative Assembly but was not added to or made a part of ORS chapter 414 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.
ORS 414.338 [2001 c.869 §1; 2009 c.595 §301; repealed by 2011 c.720 §228]
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[Repealed or reserved.]
ORS 414.340 [2001 c.869 §3; 2005 c.381 §15; repealed by 2009 c.263 §1]
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[Repealed or reserved.]
ORS 414.342 [2001 c.869 §4; repealed by 2009 c.263 §1]
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[Repealed or reserved.]
ORS 414.344 [2001 c.869 §10; repealed by 2009 c.263 §1]
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[Repealed or reserved.]
ORS 414.346 [2001 c.869 §8; repealed by 2009 c.263 §1]
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[Repealed or reserved.]
ORS 414.348 [2001 c.869 §6; 2005 c.22 §285; repealed by 2009 c.263 §1]
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[Repealed or reserved.]
ORS 414.350 [1993 c.578 §1; 2009 c.595 §302; repealed by 2011 c.720 §228]
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(Pharmacy and Therapeutics Committee)
ORS 414.351 Definitions for ORS 414.351 to 414.414. As used in ORS 414.351 to 414.414
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(1) “Compendia” means those resources widely accepted by the medical profession in the efficacious use of drugs, including the following sources: (a) The American Hospital Formulary Service drug information. (b) The United States Pharmacopeia drug information. (c) The American Me…
ORS 414.353 Committee established; membership. (1) There is created an 11-member Pharmacy and Therapeutics Committee responsible for advising the Oregon Health Authority on the implementation of the retrospective and prospective programs and on the Practitioner-Managed Prescription Drug Plan
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(2) The Director of the Oregon Health Authority shall appoint the members of the committee, who shall serve at the pleasure of the director for a term of three years. An individual appointed to the committee may be reappointed upon completion of the individual’s term. The members…
ORS 414.354 Meetings; advisory committees; public notice and testimony. (1) Except as provided in ORS 414.356, the Pharmacy and Therapeutics Committee shall operate in accordance with ORS chapter 192. The committee shall annually elect a chairperson from the members of the committee
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(2) A committee member is not entitled to compensation but is entitled to reimbursement for actual and necessary travel expenses incurred in connection with the member’s duties, pursuant to ORS 292.495. (3) A quorum consists of six members of the committee. (4) The committee may …
ORS 414.355 [1993 c.578 §2; 2009 c.595 §303; repealed by 2011 c.720 §228]
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[Repealed or reserved.]
ORS 414.356 Executive session. (1) Notwithstanding ORS 192.610 to 192.705, the Pharmacy and Therapeutics Committee shall meet in an executive session for purposes of
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(a) Reviewing the prescribing or dispensing practices of individual physicians or pharmacists; (b) Discussing drug use review data pertaining to individual physicians or pharmacists; (c) Reviewing profiles of individual patients; or (d) Reviewing confidential drug pricing informa…
ORS 414.359 Mental Health Clinical Advisory Group. (1) The Mental Health Clinical Advisory Group is established in the Oregon Health Authority. The Mental Health Clinical Advisory Group shall develop evidence-based algorithms for mental health treatments, including treatments with mental health drugs based on
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(a) The efficacy of the drug; (b) The cost of the drug; (c) Potential side effects of the drug; (d) A patient’s profile; and (e) A patient’s history with the drug. (2) The Mental Health Clinical Advisory Group consists of 18 members appointed by the authority as follows: (a) Two …
ORS 414.360 [1993 c.578 §6; 2003 c.70 §1; 2009 c.595 §304; repealed by 2011 c.720 §228]
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[Repealed or reserved.]
ORS 414.361 Committee to advise and make recommendations on drug utilization review standards and interventions; preferred drug list. (1) The Pharmacy and Therapeutics Committee shall advise the Oregon Health Authority on
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(a) Adoption of rules to implement ORS 414.351 to 414.414 in accordance with ORS chapter 183. (b) Implementation of the medical assistance program retrospective and prospective programs as described in ORS 414.351 to 414.414, including the type of software programs to be used by …
ORS 414.364 Intervention approaches. In appropriate instances, interventions developed under ORS 414.361 (1)(d) may include the following
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(1) Information disseminated to prescribers and pharmacists to ensure that they are aware of the duties and powers of the Pharmacy and Therapeutics Committee. (2) Written, oral or electronic reminders of recipient-specific or drug-specific information that are designed to ensure …
ORS 414.365 [1993 c.578 §7; 2009 c.595 §305; repealed by 2011 c.720 §228]
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[Repealed or reserved.]
ORS 414.369 Prospective drug use review program. The prospective drug use review program must use guidelines established by the Oregon Health Authority that are based on the recommendations of the Pharmacy and Therapeutics Committee. The program must ensure that prior to the prescription being filled or delivered a review will be conducted by the pharmacist at the point of sale to screen for potential drug therapy problems resulting from the following
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(1) Therapeutic duplication. (2) Drug-drug interactions, including serious interactions with nonprescription or over-the-counter drugs. (3) Incorrect dosage and duration of treatment. (4) Drug-allergy interactions. (5) Clinical abuse and misuse. (6) Drug-disease contraindications…
ORS 414.370 [1993 c.578 §8; 2003 c.70 §2; repealed by 2011 c.720 §228]
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[Repealed or reserved.]
ORS 414.371 Retrospective drug use review program. The retrospective drug use review program must use
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(1) Guidelines established by the Oregon Health Authority that are based on the recommendations of the Pharmacy and Therapeutics Committee; and (2) The mechanized drug claims processing and information retrieval system to analyze claims data on drug use against explicit predeterm…
ORS 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
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(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 Thera…
ORS 414.375 [1993 c.578 §13; 2009 c.595 §306; repealed by 2011 c.720 §228]
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[Repealed or reserved.]
ORS 414.380 [1993 c.578 §12; 2009 c.595 §307; repealed by 2011 c.720 §228]
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[Repealed or reserved.]
ORS 414.381 Annual reports; educational materials; procedures to protect confidential information. In addition to the duties described in ORS 414.361, the Pharmacy and Therapeutics Committee shall do the following subject to the approval of the Director of the Oregon Health Authority
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(1) Publish an annual report, as described in ORS 414.382. (2) Publish and disseminate educational information to prescribers and pharmacists regarding the committee and the drug use review programs, including information on the following: (a) Identifying and reducing the frequen…
ORS 414.382 Requirements for annual report. (1) The annual report required under ORS 414.381 (1) is subject to public comment prior to its submission to the Director of the Oregon Health Authority and must include the following
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(a) An overview of the activities of the Pharmacy and Therapeutics Committee and the prospective and retrospective programs; (b) A summary of interventions made, including the number of cases brought before the committee and the number of interventions made; (c) An assessment of …
ORS 414.385 [1993 c.578 §11; repealed by 2011 c.720 §228]
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[Repealed or reserved.]
ORS 414.390 [1993 c.578 §10; 2009 c.595 §308; repealed by 2011 c.720 §228]
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[Repealed or reserved.]
ORS 414.395 [1993 c.578 §14; repealed by 2011 c.720 §228]
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[Repealed or reserved.]
ORS 414.400 [1993 c.578 §4; 2001 c.900 §103; repealed by 2011 c.720 §228]
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[Repealed or reserved.]
ORS 414.410 [1993 c.578 §5; 2009 c.595 §309; repealed by 2011 c.720 §228]
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[Repealed or reserved.]
ORS 414.414 Use and disclosure of confidential information. (1) Information collected under ORS 414.351 to 414.414 that identifies an individual is confidential and may not be disclosed by the Pharmacy and Therapeutics Committee, the retrospective program or the Oregon Health Authority to any person other than a health care provider appearing on a recipient’s medication profile
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(2) The staff of the committee may have access to identifying information for purposes of carrying out intervention activities. The identifying information may not be released to anyone other than a staff member of the committee, the retrospective program, the authority or a heal…
ORS 414.415 [1993 c.578 §9; repealed by 2011 c.720 §228]
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[Repealed or reserved.]
ORS 414.420 [Formerly 414.026; 2009 c.595 §309a; renumbered 411.443 in 2009]
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[Repealed or reserved.]
ORS 414.422 [Formerly 414.027; renumbered 411.445 in 2009]
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[Repealed or reserved.]
ORS 414.424 [2005 c.494 §2; 2007 c.70 §193; 2009 c.414 §1; renumbered 411.439 in 2009]
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MEDICAL ASSISTANCE FOR CERTAIN INDIVIDUALS