MedicaidCoverageMedium impact
Notice of intent – OHA will amend the Medicaid State Plan to allow fee-for-service coverage of equivalent non-covered outpatient drugs during a national shortage
Oregon Health Plan·OR·Public notice
Effective date
Jul 1, 2024
We identified it
Jun 20, 2026
Summary
Oregon Medicaid will now cover non-covered outpatient drugs (including FDA-authorized imports) during recognized critical drug shortages when the standard FDA-approved version is unavailable at pharmacies. This expands coverage options during drug shortage situations.
Action Required
By July 1, 2024: Billing team should verify with Oregon Medicaid that alternative drugs during shortages are covered before dispensing. Monitor FDA and American Society of Health-System Pharmacists drug shortage lists. Document medical necessity and shortage status for claims involving non-covered drugs used as alternatives during shortages.