Oregon Health Plan (OHP) Prescription Coverage

For members not enrolled in a CCO, OHA covers all prescriptions. These lists determine fee-for-service ("open card") coverage:

• The Preferred Drug List
• The Prioritized List of Health Services
• The federal Medicaid Drug Rebate Program
  

The Preferred Drug List is the list of medications covered for open card members. You can find this list at www.orpdl.org. To look up your medication, you should know:

• The medication's exact name
• The dose you take and
• How much your provider prescribes.
  

OHP with Limited Drug covers only certain drugs that Medicare Part D does not cover.

• If you have OHP with Limited Drug, your Medicare Part D drug plan will cover most of your prescriptions.
• OHP will pay for the ones that OHP covers, but Part D doesn't cover. These include over-the-counter drugs and barbiturates.

If you choose not to enroll in a Part D drug plan, you will have to pay for drugs that Medicare Part D would cover if you had it. This means that unless you enroll in a Part D drug plan, you will pay out-of-pocket for most of your prescriptions.

Getting Prescriptions Filled

Go to a participating pharmacy. Make sure the pharmacy knows about all your health coverage:

• OHP, 
• Your CCO, and
• Any other coverage (such as private health insurance or Medicare).

Bring a picture ID with you, such as a driver's license or passport. Show all your health coverage ID cards. If you don't have your cards yet, tell the pharmacy you have OHP.