MedicaidPrior AuthMedium impact
Limited drug coverage for Citizenship Waived Medical (CWM) benefit - Fax to prescribing providers
Oregon Health Plan·OR · Oncology, Nephrology, Psychiatry +2 more·Provider
We identified it
Jun 20, 2026
Summary
Oregon Health Authority has added limited drug coverage to the Citizenship Waived Medical (CWM) benefit, covering only cancer drugs, immunosuppressants for kidney transplant, and short-term behavioral health drugs following crisis episodes. Most prescriptions will require prior authorization with specific diagnosis documentation.
Action Required
Immediately: Billing team must verify CWM eligibility through MMIS Provider Portal or call 866-692-3864 before submitting drug claims. Providers must include diagnosis on prescriptions and request prior authorization for covered drugs by calling 888-202-2126, using MMIS portal, or faxing to 888-346-0178. Document covered diagnosis (cancer, kidney transplant, or behavioral health crisis) and for cancer drugs, attest the medication relates to cancer treatment or helps patient tolerate therapy.