1. (1) The Drug Use Review (DUR)/Pharmacy and Therapeutics Committee (P&T Committee) is composed of 11 individuals appointed by the director of the Oregon Health Authority (Authority) pursuant to ORS 414.353.

2. (2) The P&T Committee shall advise the Oregon Health Authority (Authority) on the following:

   1. (a) Implementation of the medical assistance program retrospective and prospective programs, including the type of software programs to be used by the pharmacist for prospective drug use review and the provisions of the contractual agreement between the state and any entity involved in the retrospective program;
   2. (b) Implementation of the Practitioner Managed Prescription Drug Plan (PMPDP);
   3. (c) Adoption of administrative rules pertaining to the P&T Committee;
   4. (d) Development of and application of the criteria and standards to be used in retrospective and prospective drug use review and safety edit programs in a manner that ensures that such criteria and standards are based on compendia, relevant guidelines obtained from professional groups through consensus-driven processes, the experience of practitioners with expertise in drug therapy, data and experience obtained from drug utilization review program operations. The P&T Committee must have an open professional consensus process, establish an explicit ongoing process for soliciting and considering input from interested parties, and make timely revisions to the criteria and standards based on this input and scheduled reviews;
   5. (e) Development, selection and application of and assessment for interventions being educational and not punitive in nature for medical assistance program prescribers, dispensers and patients.
3. (3) The P&T Committee shall make recommendations to the Authority, subject to approval by the Director or the Director's designee, for drugs to be included on any PDL adopted by the Authority and on the PMPDP. The P&T Committee shall also recommend all utilization controls, prior authorization requirements or other conditions for the inclusion of a drug on the PDL.

4. (4) The P&T Committee shall, with the approval of the Director or designee, do the following:

   1. (a) Publish an annual report;

   2. (b) Publish and disseminate educational information to prescribers and pharmacists regarding the P&T Committee and the drug use review programs, including information on the following:

      1. (A) Identifying and reducing the frequency of patterns of fraud, abuse or inappropriate or medically unnecessary care among prescribers, pharmacists and recipients;
      2. (B) Potential or actual severe or adverse reactions to drugs;
      3. (C) Therapeutic appropriateness;
      4. (D) Overutilization or underutilization;
      5. (E) Appropriate use of generic products;
      6. (F) Therapeutic duplication;
      7. (G) Drug-disease contraindications;
      8. (H) Drug-drug interactions;
      9. (I) Drug allergy interactions;
      10. (J) Clinical abuse and misuse.
      11. (K) Patient safety
   3. (c) 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 P&T Committee, staff of the P&T Committee, contractors to the P&T Committee or the Authority.

Statutory/Other Authority

ORS 413.042 & 414

Statutes/Other Implemented

ORS 414.065, 414.353 & 414.354

History

DMAP 71-2025, amend filed 09/25/2025, effective 10/01/2025
DMAP 5-2014, f. & cert. ef. 1-28-14
DMAP 40-2013(Temp), f. & cert. ef. 8-1-13 thru 1-28-14
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
SPD 12-2012(Temp) , f. 8-31-12, cert. ef. 9-1-12 thru 2-28-13