MedicaidPrior AuthHigh impact
Changes to fee-for-service coverage of provider-administered biologic drugs for severe asthma (for providers with recent claims for these drugs)
Oregon Health Plan·OR · Pulmonology, Allergy & Immunology, Dermatology·Provider
Effective date
Jan 1, 2022
We identified it
Jun 20, 2026
Summary
Oregon Health Plan (OHP) now requires prior authorization for all provider-administered biologic drugs for severe asthma starting January 1, 2022. Claims without approved prior authorization will be denied, and providers must request PA before patients' next scheduled doses.
Action Required
Immediately: For patients listed in the policy notification who need continued biologic therapy, billing team must request prior authorization before their next scheduled dose. Submit PA requests via phone (888-202-2126), web portal (https://www.or-medicaid.gov), or fax (888-346-0178). Include all ICD-10 diagnosis codes for primary and comorbid conditions, and document history of other treatment attempts. Claims will be denied without approved prior authorization on file.