MedicaidReimbursementMedium impact
Notice of intent – OHA will amend the Medicaid State Plan to align reimbursement for physician-administered drugs with current Medicare fee schedule - Comments due Nov. 25, 2022
Oregon Health Plan·OR · Oncology, Rheumatology, Gastroenterology +2 more·Public notice
We identified it
Jun 20, 2026
Summary
Oregon's Medicaid will temporarily increase reimbursement for certain biosimilar drugs for 5 years, aligning with new Medicare requirements from the Inflation Reduction Act. The new rate will be the biosimilar's Average Sales Price (ASP) plus 8% of the reference biological's ASP, but only applies to biosimilars that cost no more than their reference biological.
Action Required
By November 25, 2022: Billing teams in Oregon should monitor for the final State Plan Amendment approval and prepare to update billing systems with new Medicaid reimbursement rates for biosimilar drugs once CMS approves the amendment. Contact jesse.anderson@dhsoha.state.or.us with any questions during the comment period.