ORS 414.372 Pharmacy lock-in program; rules

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:

Uses three or more pharmacies in a six-month period;

Fills prescriptions from more than one prescriber for the same or comparable medications for the same time period;

Alters a prescription; or

Exhibits behaviors or patterns of behavior that the Pharmacy and Therapeutics Committee has identified as indicative of intentional overutilization or misuse.

This subsection does not apply to a recipient who:

Is a member of a coordinated care organization;

Has Medicare drug coverage, in addition to medical assistance, but no other drug coverage;

Is a child in the custody of the Department of Human Services; or

Is a patient in a hospital or other medical institution or a resident in a long term care facility.

The authority shall prescribe by rule:

Exceptions to the limitation imposed under paragraph (a) of this subsection; and

The conditions under which a recipient who is restricted under paragraph (a) of this subsection may change to a different pharmacy.

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.