MedicaidAdministrativeMedium impact
Provider Announcement
Oregon Health Plan·OR · Pharmacy·Provider
We identified it
Jun 20, 2026
Summary
Oregon Health Plan (OHP) now allows pharmacists to fill fee-for-service prescriptions up to two weeks early for chronic condition medications to prepare for COVID-19, requiring specific NCPDP override codes to bypass early refill edits in the billing system.
Action Required
Immediately: Pharmacy billing team must update claim submission protocols to include the following NCPDP override codes when processing early refills for OHP fee-for-service prescriptions: Conflict Reason Code 439-E4 (ER Overutilization), Personal Service Intervention Code 440-E5 (R0 - Pharmacist consulted), Result of Service Code 441-E6 (1B - Filled prescription as is), and Submission Clarification Code 420-DK (13 - Payer-Recognized Emergency/Disaster Assistance Request). These overrides apply only to physical health drugs for chronic conditions for non-CCO members and mental health drugs for all OHP members. Update pharmacy billing software and train staff on override entry process. Failure to use correct codes will result in claim denials for legitimate early refills. Contact Oregon Pharmacy Call Center at 888-202-2126 for prior authorization questions.