(A) Uses three or more pharmacies in a six-month period;
(B) Fills prescriptions from more than one prescriber for the same or comparable medications for the same time period;
(C) Alters a prescription; or
(D) Exhibits behaviors or patterns of behavior that the Pharmacy and Therapeutics Committee has identified as indicative of intentional overutilization or misuse.
(b) This subsection does not apply to a recipient who:
(A) Is a member of a coordinated care organization;
(B) Has Medicare drug coverage, in addition to medical assistance, but no other drug coverage;
(C) Is a child in the custody of the Department of Human Services; or
(D) Is a patient in a hospital or other medical institution or a resident in a long term care facility.
(c) The authority shall prescribe by rule:
(A) Exceptions to the limitation imposed under paragraph (a) of this subsection; and
(B) The conditions under which a recipient who is restricted under paragraph (a) of this subsection may change to a different pharmacy.
(2) The authority may conduct prospective drug utilization review, in accordance with rules adopted under ORS 414.361, prior to payment for drugs for a patient who has filled prescriptions for more than 15 drugs in the preceding six-month period. [2015 c.467 §2]
Note: See note under 414.351.