MedicaidAdministrativeMedium impact
“No Wrong Door” policy for COVID-19 therapeutics for CCO members
Oregon Health Plan·OR·Plan contract
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
Oregon Health Authority implemented a 'No Wrong Door' policy for COVID-19 therapeutics (Paxlovid, Lagevrio, molnupiravir) retroactive to January 1, 2024. Non-contracted providers can now bill OHA directly instead of CCOs, eliminating prior authorization requirements through September 30, 2024.
Action Required
Immediately: Billing team must update workflows for COVID-19 therapeutic claims retroactive to January 1, 2024. For non-contracted CCO providers, bill OHA directly instead of the CCO for Paxlovid, Lagevrio, and molnupiravir. Resubmit any denied claims from January 1-March 14, 2024 to OHA. Before October 1, 2024: Monitor CCO communications for new prior authorization requirements that take effect after the policy expires September 30, 2024.