MedicaidAdministrativeMedium impact
Point of sale dose optimization edit for select fee-for-service prescriptions effective July 11, 2022
Oregon Health Plan·OR·Provider
Effective date
Jul 11, 2022
We identified it
Jun 20, 2026
Summary
Oregon Health Plan fee-for-service pharmacy system will deny payment for select medications that can be optimized to once-daily dosing using fewer tablets/capsules. Pharmacies must resubmit claims with optimized dosing (e.g., change 'Atorvastatin 10mg, 2 tabs daily' to 'Atorvastatin 20mg, 1 tab daily') or call for overrides in specific clinical situations.
Action Required
Effective July 11, 2022: Pharmacy staff must resubmit denied prescription claims using smallest number of whole tablets/capsules per dose when clinically appropriate. If prior authorization is required after resubmission, call Oregon Pharmacy Call Center (888-202-2126) to transfer existing PA to new strength. Complete and send notification form to prescribers for all dose optimization changes. Call for overrides when optimization is clinically inappropriate or patient is titrating medications.