{"data":{"id":"us-or/ors-414.372","jurisdiction":"us-or","citation":"ORS 414.372","heading":"Pharmacy lock-in program; rules.","body":"(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) 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.","path":["11 - Juvenile Code, Human Services","34. Human Services; Juvenile Code; Corrections","Chapter 414 — Medical Assistance"],"source_url":"https://www.oregonlegislature.gov/bills_laws/ors/ors414.html","current_through":"2025 Edition","vintage":"","retrieved_at":"2026-09-03T23:50:14Z","sha256":"d86ba2d77f41de5936964534ddd3931231170f9453c4025e2f176989bb22e650","source_id":"us-or","stale":false,"prev":"us-or/ors-414.371","next":"us-or/ors-414.375"},"notice":"GroundRules: Original legal text. Not legal advice."}