1. (1) The Division of Medical Assistance Programs may impose prescription drug payment limitations on clients with more than 15 unique fee-for-service drug prescriptions in a six-month period.
2. (2) The Division will review the client’s drug therapy in coordination with the client's prescribing practitioner to evaluate for appropriate drug therapy.

3. (3) Appropriate drug therapy criteria will include, but is not limited to, the following:

   1. (a) Overuse of selected drug classes;
   2. (b) Under-use of generic drugs;
   3. (c) Therapeutic drug duplication;
   4. (d) Drug to disease interactions;
   5. (e) Drug to drug interactions;
   6. (f) Inappropriate drug dosage;
   7. (g) Drug selection for age;
   8. (h) Duration of treatment;
   9. (i) Clinical abuse or misuse.
4. (4) The Division Medical Director in conjunction with the Drug Use Review/Pharmacy & Therapeutics Committee will make final determinations on imposed drug prescription payment limitations relating to this policy.

Statutory/Other Authority

ORS 413.042

Statutes/Other Implemented

ORS 414.065

History

DMAP 61-2012, f. 12-27-12, cert. ef. 1-1-13
DMAP 42-2012(Temp), f. & cert. ef. 9-12-12 thru 3-10-13
DMAP 12-2012(Temp), f. & cert. ef. 3-16-12 thru 9-11-12
DMAP 27-2011(Temp), f. & cert. ef. 9-30-11 thru 3-15-12
OMAP 1-2004, f. 1-23-04, cert. ef. 2-1-04