Oregon Code § 414.372·Enacted ·Last updated March 01, 2026
Statute Text
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, 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.