MedicaidPrior AuthHigh impact
Changes to fee-for-service coverage of pharmacy and physician-administered claims for antineoplastic drugs
Oregon Health Plan·OR · Oncology, Hematology·Provider
Effective date
Oct 1, 2020
We identified it
Jun 20, 2026
Summary
Oregon Health Plan (OHP) now requires prior authorization for fee-for-service pharmacy and physician-administered claims for antineoplastic drugs approved by FDA after 2007, effective October 1, 2020. Claims without approved prior authorization will be denied, with 24-hour response time for PA requests.
Action Required
Before October 1, 2020: Billing team and providers must obtain prior authorization for all new antineoplastic therapy using FDA-approved drugs after 2007 for OHP fee-for-service patients. Submit PA requests via phone (888-202-2126), Provider Web Portal, or fax (888-346-0178) with required documentation including ICD-10 diagnosis codes, cancer stage, biomarkers, and therapy details. Claims will be denied without approved prior authorization.