Pharmacy Information and Preferred Drug List Changes - First Quarter 2024
Date: 01/30/24
Updates to COVID-19 Vaccine Coverage
The Oregon Health Authority (OHA) has partially reversed the requirement to return to use of Vaccines for Children (VFC) providers as the established pathway for children’s vaccines for Oregon Health Plan members. In addition to VFC providers, Trillium members under age 19 are now covered to receive COVID-19 vaccines from any Oregon Medicaid contracted pharmacy, regardless of VFC enrollment, through September 30, 2024. For additional information visit OHA's COVID-19 Oregon Health Plan provider guidance site.
Trillium Community Health Plan Preferred Drug List Changes
Trillium’s Preferred Drug List (PDL) is updated monthly and is available online. View the Pharmacy Information and Preferred Drug List Changes - First Quarter 2024 notice (PDF) for a summary of the PDL changes made in the first quarter of 2024. For the most current preferred drug list, visit the Pharmacy section of our website.
Prior Authorization Changes to Specialized Medications Given in Office
View the Pharmacy Information and Preferred Drug List Changes - First Quarter 2024 notice (PDF) for the list of new HCPC codes. These codes now require prior authorization for coverage for Trillium Oregon Health Plan members.
Quarterly Update on Pharmacy Coverage Guidelines
The P&T Committee determines updates to coverage guidelines (criteria) based on quarterly, comprehensive reviews. Criteria serves as a reference for providers to use when prescribing pharmaceutical products for Trillium members with pharmacy coverage. Prior authorization (PA) does not guarantee payment. PA determination is based on multiple factors in conjunction to the criteria posted in drug coverage guidelines. These factors include but are not limited to: treatment of a funded vs non-funded condition as defined by the Oregon Prioritized List and applicable guidelines; prior trial and failure of agents on the PDL; comparative costs of available treatment options.
- View the Pharmacy Information and Preferred Drug List Changes - First Quarter 2024 notice (PDF) for all the updated or new Trillium Community Health Plan coverage guidelines that were approved by P&T in the first quarter of 2024. All coverage guidelines will go into effect April 1, 2024 and will become available to view in their entirety on the Policies & Criteria section of our website approximately 2 weeks prior to their implementation date.
Additional Information
For additional information regarding changes to the Trillium Preferred Drug List (PDL), contact Trillium by telephone at 1-877-600-5472. For the most current version of the PDL, visit the Pharmacy section of our website.
For additional information on medication coverage guidelines, visit the Provider Resources section of Trillium’s website.
If you have questions regarding the information contained in this update, contact Trillium Provider Services through the Provider Resources section of Trillium’s website or by telephone at 1-877-600-5472.