MedicaidCoverageMedium impact
Limited drug coverage for Citizenship Waived Medical (CWM) benefit - Fax to pharmacies
Oregon Health Plan·OR · Oncology, Nephrology, Psychiatry +2 more·Provider
We identified it
Jun 20, 2026
Summary
Oregon Health Authority added limited drug coverage for Citizenship Waived Medical (CWM) members, covering only cancer drugs, immunosuppressants for kidney transplant, and short-term behavioral health drugs after crisis episodes. Prior authorization is required for most covered drugs through three submission methods.
Action Required
Immediately: Staff must verify CWM eligibility via MMIS Provider Portal or 866-692-3864 before prescribing covered drugs. For covered conditions, obtain prior authorization by calling 888-202-2126, submitting via MMIS portal, or faxing to 888-346-0178. Document diagnosis in all PA requests and include crisis/emergency visit documentation for behavioral health drugs. Complete OHP 3166 form for non-covered prescriptions.