Prior Authorization in Oregon
Oregon enacted HB 2623 (2019) establishing step therapy exception requirements. The law provides exceptions for contraindications, prior failures, expected inefficacy, and patient stability. Oregon requires PA decisions within 2 business days for standard and 24 hours for urgent requests.
Key Facts About PA in Oregon
- ✓ Standard PA decisions required within 2 business days; urgent within 24 hours
- ✓ Step therapy exceptions include patient stability criterion
- ✓ Oregon Division of Financial Regulation provides external review
- ✓ Oregon Health Plan (Medicaid) uses coordinated care organizations (CCOs)
Quick Stats
- Typical Appeal Filing Window: 30 days
- External Review Available: Yes
- Major Payers: 4
Top Payers in Oregon
RxCheckUp generates payer-specific Letters of Medical Necessity for each of these Oregon carriers:
Regence BCBS OregonProvidence Health PlanPacificSourceKaiser Permanente NW