justicedao/ipfs_state_laws huggingface dataset:
ORS Chapter 414 — Medical Assistance

ORS 414.290. [1957 c.692 7(3); repealed by 1963 c.631 2]
ORS Chapter 414 — Medical Assistance

ORS 414.310. [1957 c.692 9; 1961 c.130 2; repealed by 1963 c.631 2] PRESCRIPTION DRUGS (Oregon Prescription Drug Program)
ORS Chapter 414 — Medical Assistance

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. (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 dispensing fee set by the authority. (4) Prescription drug identification cards issued under this section must contain the information necessary for proper claims adjudication or transmission of price data. [2003 c.714 2; 2007 c.67 2; 2007 c.697 18; 2009 c.595 292] Note: See note under
ORS Chapter 414 — Medical Assistance

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] Note: See note under
ORS Chapter 414 — Medical Assistance

ORS 414.320. 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 Chapter 414 — Medical Assistance

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. (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; 2013 c.14 7] Note:
ORS Chapter 414 — Medical Assistance

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] Note:
ORS Chapter 414 — Medical Assistance

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 patients prescription drugs so that drugs that are refilled at the same frequency may be refilled concurrently. (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 of medical assistance who are not enrolled in a coordinated care organization.
ORS Chapter 414 — Medical Assistance

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: (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 covered classes of drugs; (c) Identification of the classes of drugs not covered under Medicare Part D prescription drug coverage for which federal financial participation is available and that are covered classes of drugs; and (d) Cost-sharing obligations related to the provision of Part D classes of drugs for which federal financial participation is not available. (2) As used in this section, covered classes of drugs means classes of prescription drugs provided to persons eligible for prescription drug coverage under the state medical assistance program or Title XIX of the Social Security Act. [2005 c.754 1; 2009 c.595 298] Note:
ORS Chapter 414 — Medical Assistance

ORS 414.330. Legislative findings on prescription drugs. The Legislative Assembly finds that: (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 the most effective drugs in the most cost-effective manner will benefit both patients and taxpayers. [2001 c.897 1; 2009 c.595 298a] Note:
ORS Chapter 414 — Medical Assistance

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: (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 and consider the health condition of a patient or characteristics of a patient, including the patients gender, race or ethnicity; and (3) The cost of prescription drugs in the medical assistance program is managed through market competition among pharmaceutical manufacturers by considering, first, the effectiveness and safety of a given drug and, second, any substantial cost differences between drugs within the same therapeutic class. [2001 c.897 2; 2009 c.595 298b; 2011 c.720 137] Note: See note under
ORS Chapter 414 — Medical Assistance

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. (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 assistance program and ensure that practitioners receive educational materials and have access to training on the Practitioner-Managed Prescription Drug Plan. (4) Notwithstanding the Practitioner-Managed Prescription Drug Plan adopted by the authority, a practitioner may prescribe any drug that the practitioner indicates is medically necessary for an enrollee as being the most effective available. (5) An enrollee may appeal to the authority a decision of a practitioner or the authority to not provide a prescription drug requested by the enrollee. (6) This section does not limit the decision of a practitioner as to the scope and duration of treatment of chronic conditions, including but not limited to arthritis, diabetes and asthma. [2001 c.897 3; 2009 c.595 299; 2009 c.827 4,10; 2011 c.720 138,139] Note: See note under
ORS Chapter 414 — Medical Assistance

ORS 414.337. 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. Note: Sections 3 and 4, chapter 544, Oregon Laws 2019, provide: Sec. 3. (1) As used in this section, mental health drug means a type of legend drug defined by the Oregon Health Authority by rule that includes but is not limited to: (a) Therapeutic class 7 ataractics-tranquilizers; and (b) Therapeutic class 11 psychostimulants-antidepressants. (2) Notwithstanding ORS 414.334, the authority shall reimburse the cost of a mental health drug prescribed for a medical assistance recipient if federal financial participation in the cost is available. [2019 c.544 3] Sec. 4. Section 3, chapter 544, Oregon Laws 2019, is repealed on January 2, 2026.
ORS Chapter 414 — Medical Assistance

ORS 414.350. [1993 c.578 1; 2009 c.595 302; repealed by 2011 c.720 228] (Pharmacy and Therapeutics Committee)
ORS Chapter 414 — Medical Assistance

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. (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 individuals term. The membership of the committee shall be composed of the following: (a) Five persons licensed as physicians under ORS 677.100 to 677.228 and actively engaged in the practice of medicine in Oregon, who may be from among persons recommended by organizations representing physicians; (b) Four persons licensed in and actively practicing pharmacy in Oregon who may be from among persons recommended by organizations representing pharmacists whether affiliated or unaffiliated with any association; and (c) Two persons who are not physicians or pharmacists. (3) If the committee determines that it lacks current clinical or treatment expertise with respect to a particular therapeutic class, or at the request of an interested outside party, the director shall appoint one or more medical experts otherwise qualified as described in subsection (2)(a) of this section who have such expertise. The medical experts shall have full voting rights with respect to recommendations made under ORS 414.361 (3) and (4). The medical experts may participate but may not vote in any other activities of the committee. (4) The director shall fill a vacancy on the committee by appointing a new member to serve the remainder of the unexpired term. [2011 c.720 2; 2017 c.409 9] Note: See note under
ORS Chapter 414 — Medical Assistance

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. (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 members duties, pursuant to ORS 292.495. (3) A quorum consists of six members of the committee. (4) The committee may establish advisory committees to assist in carrying out the committees duties under ORS 414.351 to 414.414, with the approval of the Director of the Oregon Health Authority. (5) The Oregon Health Authority shall provide staff and support services to the committee. (6) The committee shall meet no less than four times each year at a place, day and hour determined by the director. The committee also shall meet at other times and places specified by the call of the director or a majority of the members of the committee. No less than 30 days prior to a meeting the committee shall post to the authority website: (a) The agenda for the meeting; (b) A list of the drug classes to be considered at the meeting; and (c) Background materials and supporting documentation provided to committee members with respect to drugs and drug classes that are before the committee for review. (7) The committee shall provide appropriate opportunity for public testimony at each regularly scheduled committee meeting. Immediately prior to deliberating on any recommendations regarding a drug or a class of drugs, the committee shall accept testimony, in writing or in person, that is offered by a manufacturer of those drugs or another interested party. (8) The committee may consider more than 20 classes of drugs at a meeting only if: (a) There is no new clinical evidence for the additional class of drugs; and (b) The committee is considering only substantial cost differences between drugs within the same therapeutic class. [2011 c.720 11] Note: See note under
ORS Chapter 414 — Medical Assistance

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: (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 information, including substantial cost differences between drugs within the same therapeutic class, that is necessary for the committee to make final recommendations under ORS 414.361 or to comply with ORS 414.414. (2) A meeting held in executive session is subject to the requirements of ORS 192.650 (2). [2011 c.720 10] Note: See note under
ORS Chapter 414 — Medical Assistance

ORS 414.364. Intervention approaches. In appropriate instances, interventions developed under ORS 414.361 (1)(d) may include the following: (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 recipient, prescriber and pharmacist confidentiality, and suggested changes in the prescribing or dispensing practices designed to improve the quality of care. (3) Face-to-face discussions between experts in drug therapy and the prescriber or pharmacist who has been targeted for educational intervention. (4) Intensified reviews or monitoring of selected prescribers or pharmacists. (5) Educational outreach through the retrospective program focusing on improvement of prescribing and dispensing practices. (6) The timely evaluation of interventions to determine if the interventions have improved the quality of care. (7) The review of case profiles before the conducting of an intervention. (8) The actions specified in ORS 414.372. [2011 c.720 6; 2015 c.467 6] Note: See note under
ORS Chapter 414 — Medical Assistance

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: (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. [2011 c.720 7] Note: See note under
ORS Chapter 414 — Medical Assistance

ORS 414.371. Retrospective drug use review program. The retrospective drug use review program must use: (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 predetermined standards that are based on compendia and other sources to monitor the following: (a) Therapeutic appropriateness. (b) Overutilization or underutilization. (c) Fraud and abuse. (d) Therapeutic duplication. (e) Drug-disease contraindications. (f) Drug-drug interactions. (g) Incorrect drug dosage or duration of drug treatment. (h) Clinical abuse and misuse. [2011 c.720 8] Note: See note under
ORS Chapter 414 — Medical Assistance

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 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
ORS Chapter 414 — Medical Assistance

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: (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 frequency of patterns of fraud, abuse or inappropriate or medically unnecessary care among prescribers, pharmacists and recipients. (b) Potential or actual severe or adverse reactions to drugs. (c) Therapeutic appropriateness. (d) Overutilization or underutilization. (e) Appropriate use of generic products. (f) Therapeutic duplication. (g) Drug-disease contraindications. (h) Drug-drug interactions. (i) Drug allergy interactions. (j) Clinical abuse and misuse. (3) Adopt and implement procedures designed to ensure the confidentiality of any information that identifies individual prescribers, pharmacists or recipients and that is collected, stored, retrieved, assessed or analyzed by the committee, staff of the committee, the Oregon Health Authority or contractors to the committee or the authority. [2011 c.720 5] Note: See note under
ORS Chapter 414 — Medical Assistance

ORS 414.382. Requirements for annual report. (1) The annual report required under ORS
ORS Chapter 414 — Medical Assistance

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 recipients medication profile. (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 health care provider appearing on a recipients medication profile or, for purposes of investigating potential fraud in programs administered by the authority, the Department of Justice. (3) The committee may release cumulative, nonidentifying information for the purposes of legitimate research and for educational purposes. [2011 c.720 9] Note: See note under
ORS Chapter 414 — Medical Assistance

ORS 414.420. [Formerly
ORS Chapter 414 — Medical Assistance

ORS 414.422. [Formerly
ORS Chapter 414 — Medical Assistance

ORS 414.424. [2005 c.494 2; 2007 c.70 193; 2009 c.414 1; renumbered 411.439 in 2009] MEDICAL ASSISTANCE FOR CERTAIN INDIVIDUALS
ORS Chapter 414 — Medical Assistance

ORS 414.426. Payment of cost of medical care for institutionalized persons. The Oregon Health Authority is hereby authorized to pay the cost of care for patients in institutions operated under ORS 179.321 under the medical assistance program established by ORS chapter 414. [Formerly 414.028; 2009 c.595 310] Note:
ORS Chapter 414 — Medical Assistance

ORS 414.428. Coverage for American Indian and Alaska Native beneficiaries. (1) An individual who is eligible for or receiving medical assistance, as defined in ORS 414.025, pursuant to a demonstration project under section 1115 of the Social Security Act and who is an American Indian and Alaska Native beneficiary shall receive the same package of health services as individuals described in ORS 414.706 (1), (2) and (3) if: (a) The Oregon Health Authority receives 100 percent federal medical assistance percentage for payments made by the authority for the package of health services provided; or (b) The authority receives funding from the Indian tribes for which federal financial participation is available. (2) As used in this section, American Indian and Alaska Native beneficiary has the meaning given that term in ORS 414.631. [Formerly 414.029; 2007 c.861 22; 2009 c.595 311; 2011 c.602 39; 2013 c.688 74; 2021 c.97 40] Note:
ORS Chapter 414 — Medical Assistance

ORS 414.430. Access to dental care for pregnant women; rules. (1) The Oregon Health Authority shall prescribe by rule appropriate time frames within which a pregnant medical assistance recipient whose medical assistance is reimbursed on a fee-for-service basis and who needs general or specialty dental care must have the opportunity to be seen, or referred for, and provided: (a) Emergency dental services; (b) Urgent dental services; (c) Routine dental services; and (d) An initial dental screening or examination. (2) The time frames prescribed by the authority for recipients whose medical assistance is reimbursed on a fee-for-service basis shall be the same as or shorter than the time frames for pregnant recipients enrolled in coordinated care organizations and dental care organizations.