MedicaidCoverageMedium impact
Amended dispensing limitations for certain hormone medications
Oregon Health Plan·OR · Pharmacy, Endocrinology, OB-GYN·Provider
Effective date
Jul 9, 2026
We identified it
Jul 11, 2026
Summary
Oregon Health Authority (OHA) updated OAR 410-121-0146 to allow reimbursement for up to 365-day supplies of select hormone medications (estrogens, progesterones, aldosterone antagonists, androgens, and GNRH agonists) for OHP Open Card (fee-for-service) members. This change takes effect immediately for prescriptions filled on or after July 9, 2026, and applies only to preferred drugs in specified therapeutic classes.
Action Required
By July 9, 2026: Billing team must update pharmacy billing system to accept and process up to 365-day supply claims for OHP Open Card members for the following therapeutic classes: Estrogen (STC 61), Progesterone (STC 62), Aldosterone antagonists (STC 53), Androgens (STC 60), and GNRH agonists (P1M, P1P, V1O). Train pharmacy staff to verify prescriptions are for preferred drugs only and to bill OHA accordingly for the full 365-day quantity. For members with other insurance as primary, continue billing primary insurance first and apply primary plan limitations. Contact Brandon Wells (503-508-7234) or DMAP.RXQUESTIONS@odhsoha.oregon.gov with questions.