Attention: Sublocade and Brixadi update
September 1st, 2024: long-acting buprenorphine injections (Sublocade and Brixadi) are now covered on the pharmacy benefit for OHP without a prior authorization. This means Sublocade and Brixadi can be dispensed at pharmacies instead of only being available through buy-and-bill. Sublocade and Brixadi are still covered through buy-and-bill without a prior authorization. When dispensed from a pharmacy, Sublocade and Brixadi have quantity limits that must be met. If prescriptions are written for incorrect quantities and/or day supplies, claims may not pay. If these quantity limits need to be exceeded, a prior authorization is required. Please refer to the FDA labeling for Sublocade and Brixadi for dosing.
Quantity Limits:
Sublocade (FDA Label)
- 300mg dose: 300mg every 4 weeks (1.5 mL every 4 weeks)
- 100mg: 100mg every 4 weeks (0.5 mL every 4 weeks)
Brixadi (FDA Label)
- 8mg weekly dose: 8mg every 7 days (0.16mL every 7 days)
- 16mg weekly dose: 16mg every 7 days (0.32mL every 7 days)
- 24mg weekly dose: 24mg every 7 days (0.48mL every 7 days)
- 32mg weekly dose: 32mg every 7 days (0.64mL every 7 days)
- 64mg monthly dose: 64mg every 4 weeks (0.18mL every 4 weeks)
- 96mg monthly dose: 96mg every 4 weeks (0.27mL every 4 weeks)
- 128mg monthly dose: 128mg every 4 weeks (0.36mL every 4 weeks)
Welcome to our pharmacy resources page. Here you’ll find information about our Pharmacy Help Desk, formulary, policies and forms and more. Click here to read more about our MEDS Ed program.
Pharmacy Help Desk
The Pharmacy Help Desk provides resources for providers, pharmacists, pharmacy technicians and supporting staff.
Customer Service:
503-416-4100 or toll-free 800-224-4840
8 a.m. to 5 p.m. Monday through Friday
OptumRx for after hours:
Medicare members: 866-325-7344
Medicaid (OHP) members: 844-245-0449
Other topics
Click below to learn about other pharmacy-related topics.
The formulary list provides a directory of all the preferred medications currently approved for Health Share/CareOregon members. Use the link below to view the formulary in PDF format.
- CareOregon OHP formulary (updated 10/1/2024)
- Download a machine-readable format (JSON) of the Formulary
You can search for a drug in one of the following ways:
- Find the drug listed in the formulary PDF index.
- In the PDF file, enter the drug name into the search box located in the menu.
- Call Customer Service at 503-416-4100, toll-free 800-224-4840 or TTY 711.
Note: If you are a provider looking for the CareOregon Advantage formulary, please visit the CareOregon Advantage website.
Formulary updates
CareOregon makes regular formulary updates. Use the links below to view the most recent changes in PDF format.
October 1, 2024
CareOregon (OHP) Formulary Update
March 1, 2024
Authorization Guidelines - Injectable Drugs for Bleeding and Clotting Disorders
October 1, 2024
Authorization Policy - Injectables/Medications Administered Under the Medical Benefit
October 1, 2024
CareOregon (OHP) Formulary Updates - New Generics
June 6, 2019
New Restrictions to Acute Opioid Prescribing
October 3, 2023
CareOregon (OHP) and CareOregon Advantage (Medicare) - Vaccine Coverage Guide
Policies and forms can be downloaded using the links below. If you have any questions or are unable to locate the form you need, please contact Provider Customer Service at the numbers above.
Pharmacy policies
- CareOregon OHP Prior Authorization Use Criteria (updated 10/2024)
Medicaid and Medicare
- Prior Authorization and Formulary Exception Request form (OHP only)
- Injectable Medication Administered by Provider Authorization form
- Hepatitis C Prior Authorization Request form (OHP only)
- Nutritional Supplement Medication Request form
- Pharmacy Provider Reconsideration Request form
Medicare only
- Home Infusion Prior Authorization Form
- Prior Authorization and Formulary Exception Request form (Medicare only)
- Prior Authorization and Formulary Exception Request form (Provided by Medicare)
- Hospice Prior Authorization form (Medicare Part D)
- Part D Vaccines Administered in the Medical Office Authorization & Reimbursement form
Pharmacy policy updates and other forms
- Authorization Policy-Injectables/Medications Administered Under the Medical Benefit (Updated 10/2024)
- Authorization Guidelines - Injectable Drugs for Bleeding and Clotting Disorders (Updated 3/2024)
- Opioid Lock-in form
- HepC DUR Provider Update
MAP ID application form
CareOregon is a managed care plan contracted with the Oregon Health Authority (OHA). As a contracted plan, CareOregon is required to encounter all claims received to OHA. In order to encounter a claim, the rendering and billing providers must first be verified as eligible to receive payment by OHA and issued an ID number. This ID number is for the purposes of claim processing solely and does not imply you are contracting with CareOregon or OHA. By completing the application in its entirety, you are meeting minimum conditions for claim processing.
Treatment Pathways
Additional resources
Download the MEDS Chart here in English or Spanish.
Obtaining a complete list of a patient’s medications can be difficult. It can be equally hard to find out how patients feel their meds are working, and how they are actually taking them. There may be medication-related problems that can be avoided by asking the right questions. It’s not always easy for patients to understand how to take their medications, especially when there are many prescriptions from several prescribers. Pill bottles don’t always show the name of the indication that they are meant to treat. Using the MEDS Chart helps patients voice how they feel their medications are working for them, and to work more closely with caregivers and clinicians to:
- Discover if medications are working.
- Find out what’s really going on with adherence.
- Improve medication safety.
- Promote better health outcomes.
The MEDS Chart helps patients reinforce the reason for taking a medication, allowing them to better express how they feel about taking it and express any concerns they have.
We encourage CareOregon providers to check the U.S. Food and Drug Administration MedWatch website and sign up for the FDA Drug Safety Newsletter to receive safety alerts via email. We will inform you if CareOregon takes any formulary actions in response to a safety alert.
Be sure to report serious adverse events and medication errors. A medication error is "any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient or consumer. Such events may be related to professional practice; health care products, procedures and systems, including prescribing; order communication; product labeling, packaging and nomenclature; compounding; dispensing; distribution; administration; education; monitoring and use."
- Report serious adverse medication reactions, product quality problems and usage errors online at fda.gov/medwatch, by phone or by submitting a MedWatch 3500 form by mail or fax.
The Pharmacy and DME teams partnered to create an information sheet for diabetes supplies. The CareOregon Diabetes Resource Guide is a chart of covered supplies and requirements under OHP Pharmacy, OHP DME, CareOregon Advantage Pharmacy Part B and CareOregon Advantage DME. You’ll also find contact information for statewide diabetes DME providers.
