MedicaidAdministrativeLow impact
Annual Pharmacy Benefit Manager Subcontract compliance audit
Oregon Health Plan·OR·Plan contract
Effective date
Jan 1, 2025
We identified it
Jun 20, 2026
Summary
The Oregon Health Authority has waived the requirement for Coordinated Care Organizations (CCOs) to conduct annual third-party compliance audits of their Pharmacy Benefit Manager subcontracts for contract year 2025. The first audit will now be due in 2026 covering the 2025 period.
Action Required
No immediate action required for billing teams. This is an administrative waiver that affects CCO compliance requirements only and does not change billing procedures, prior authorization requirements, or pharmacy benefit processing.