Pharmacy resources

Policies and forms can be downloaded using the links below. If you have any questions or are unable to locate the form you need, please contact Provider Customer Service at the numbers above.

Pharmacy policies

• CareOregon OHP Prior Authorization Use Criteria (updated 4/2025)

Medicaid and Medicare

• Prior Authorization and Formulary Exception Request form (OHP only)
• Injectable Medication Administered by Provider Authorization form
• Hepatitis C Prior Authorization Request form (OHP only)
• Nutritional Supplement Medication Request form
• Appointment of representative form

Medicare only

• Home Infusion Prior Authorization
• Prior Authorization and Formulary Exception Request form (Medicare only)
• Prior Authorization and Formulary Exception Request form (Provided by Medicare)
• Hospice Prior Authorization form (Medicare Part D)
• Part D Vaccines Administered in the Medical Office Authorization & Reimbursement form
  

Pharmacy policy updates and other forms

• Authorization Policy-Injectables/Medications Administered Under the Medical Benefit (Updated 4/2025)
• Authorization Guidelines - Injectable Drugs for Bleeding and Clotting Disorders (Updated 3/2024)
• Opioid Lock-in form 
• HepC DUR Provider Update

MAP ID application form

CareOregon is a managed care plan contracted with the Oregon Health Authority (OHA). As a contracted plan, CareOregon is required to encounter all claims received to OHA. In order to encounter a claim, the rendering and billing providers must first be verified as eligible to receive payment by OHA and issued an ID number. This ID number is for the purposes of claim processing solely and does not imply you are contracting with CareOregon or OHA. By completing the application in its entirety, you are meeting minimum conditions for claim processing.

MAP ID application form

Treatment Pathways

• CareOregon Diabetes Treatment Pathway
• CareOregon Advantage Diabetes Treatment Pathway
• CareOregon Asthma Treatment Pathway - Pediatrics and Adults

Additional resources

• Provider Policies and Forms
• CareOregon Provider Support
• Best Practice Guidelines