1. (1) Unless an exception applies under subsections (3)(a) or (b) of this rule, CAREAssist clients must use an Authority-approved CAREAssist in-network pharmacy for all:

   1. (a) Medications not designated as acute on the CAREAssist formulary;
   2. (b) Chronic care medications; and
   3. (c) Medications paid for in full by the Authority
2. (2) The Authority must provide to each client a list of approved pharmacies and post the information on the CAREAssist website.

3. (3) A CAREAssist client may use a non-CAREAssist in-network pharmacy if:

   1. (a) His or her insurance carrier requires use of a pharmacy that is not a CAREAssist in-network pharmacy; and
   2. (b) He or she has provided the Authority with a copy of the insurance summary of benefits for that insurance plan and the requirement to use a non-CAREAssist in-network pharmacy is explicitly stated in that insurance summary.

Statutory/Other Authority

ORS 413.042, 431.250 & 431.830

Statutes/Other Implemented

ORS 431.250 & 431.830

History

PH 30-2014, f. 11-10-14, cert. ef. 12-1-14