Insights

OR State Updates - 2015 Jan 16 No.01


On May 27, 2015, the Oregon Department of Consumer and Business Services adopted a new permanent rule, OAR 836-053-1205, relating to a “Uniform Prescription Drug Prior Authorization Request Form.” This new requirement was initially established by the 2013 Legislative Assembly in Senate Bill 382, and the subsequent adoption of this rule carries out the legislative requirement.

Acceptance of this form by all payers in Oregon is expected to streamline and simplify requests for prior approval for prescription drugs prescribed by providers. The rule applies to:

Health insurers

Third party administrators

Prepaid managed care health services organizations

Any person or public body that either individually or jointly establishes a self-insurance plan, program or contract, including but not limited to:

Persons and public bodies that are otherwise exempt from the Insurance Code under ORS 731.036

Health care clearinghouses or other entities that process or facilitate the processing of health care financial and administrative transactions from a nonstandard format to a standard format

Any other person identified by the department that processes health care financial and administrative transactions between a health care provider and an entity described in this subsection.

The rule does not require payers to reject a request for prior authorization for a prescription drug if the provider submits a form other than the uniform form, but it does require a payer to accept the form whenever it is used by a provider to submit a request.

The requirement to accept this uniform prior authorization form applies to payers on and after July 1, 2015, although the rule is effective as of May 27, 2015.

Final Rule »