ORS Chapter 414 — Medical Assistance

ORS 414.351. Definitions for ORS 414.351 to 414.414. As used in ORS 414.351 to 414.414: (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 Medical Association drug evaluations. (d) Peer-reviewed medical literature. (e) Drug therapy information provided by manufacturers of drug products consistent with the federal Food and Drug Administration requirements. (2) Criteria means the predetermined and explicitly accepted elements based on compendia that are used to measure drug use on an ongoing basis to determine if the use is appropriate, medically necessary and not likely to result in adverse medical outcomes. (3) Drug-disease contraindication means the potential for, or the occurrence of, an undesirable alteration of the therapeutic effect of a given prescription because of the presence, in the patient for whom it is prescribed, of a disease condition or the potential for, or the occurrence of, a clinically significant adverse effect of the drug on the patients disease condition. (4) Drug-drug interaction means the pharmacological or clinical response to the administration of at least two drugs different from that response anticipated from the known effects of the two drugs when given alone, which may manifest clinically as antagonism, synergism or idiosyncrasy. Such interactions have the potential to have an adverse effect on the individual or lead to a clinically significant adverse reaction, or both, that: (a) Is characteristic of one or any of the drugs present; or (b) Leads to interference with the absorption, distribution, metabolism, excretion or therapeutic efficacy of one or any of the drugs. (5) Drug use review means the programs designed to measure and assess on a retrospective and a prospective basis, through an evaluation of claims data, the proper utilization, quantity, appropriateness as therapy and medical necessity of prescribed medication in the medical assistance program. (6) Intervention means an action taken by the Oregon Health Authority with a: (a) Prescriber or pharmacist to inform about or to influence prescribing or dispensing practices; or (b) Recipient, prescriber or pharmacist to inform about or to influence the utilization of drugs. (7) Overutilization means the use of a drug in quantities or for durations that put the recipient at risk of an adverse medical result. (8) Pharmacist means an individual who is licensed as a pharmacist under ORS chapter 689. (9) Prescriber means any person authorized by law to prescribe drugs. (10) Prospective program means the prospective drug use review program described in ORS 414.369. (11) Retrospective program means the retrospective drug use review program described in ORS 414.371. (12) Standards means the acceptable prescribing and dispensing methods determined by compendia, in accordance with local standards of medical practice for health care providers. (13) Therapeutic appropriateness means drug prescribing based on scientifically based and clinically relevant drug therapy that is consistent with the criteria and standards developed under ORS 414.351 to 414.414. (14) Therapeutic duplication means the prescribing and dispensing of two or more drugs from the same therapeutic class such that the combined daily dose puts the recipient at risk of an adverse medical result or incurs additional program costs without additional therapeutic benefits. (15) Underutilization means that a drug is used by a recipient in insufficient quantity to achieve a desired therapeutic goal. [2011 c.720 1; 2015 c.467 5] Note: