Pharmacy Information and Preferred Drug List Changes - First Quarter 2026
Date: 01/30/26
Trillium Community Health Plan Oral and Enteral Nutrition Coverage Update
Effective February 1, 2026, select oral and enteral nutrition products will be covered under the Pharmacy benefit in addition to existing DME (Durable Medical Equipment; Medical benefit) coverage.
The preferred method for member access remains through the DME benefit, as most products do not require prior authorization when billed through medical DME coverage. Coverage under the Pharmacy benefit will require prior authorization for all products.
Providers are encouraged to continue utilizing the DME benefit whenever possible to minimize authorization requirements and support timely member access.
See the updated February Preferred Drug List (PDL) for full list of oral and enteral nutrition products now available through the Pharmacy benefit available on the Pharmacy section of our website.
Trillium Community Health Plan Preferred Drug List Changes
Trillium’s Preferred Drug List (PDL) is updated monthly and is available online. View this notice (PDF) for a summary of the PDL changes made in the first quarter of 2026. For the most current preferred drug list, visit the Pharmacy section of our website.
Prior Authorization Changes to Specialized Medications Given in Office
View this notice (PDF) for 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 this 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 2026. All coverage guidelines will go into effect April 1, 2026 and will become available to view in their entirety at 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 the Trillium 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 the Trillium website or by telephone at 1-877-600-5472.