Pharmacy Information for Providers
The Advanced Health Formulary is a list of medications that are covered for Advanced Health members. Some medications listed on the formulary require a prior authorization to ensure the least costly alternatives for treatment are utilized, and the condition being treated is funded for coverage by Oregon Health Plan.
Any medication may be requested for coverage, regardless of formulary status, through the prior authorization process.
Submission of a prior authorization request is not a guarantee of coverage, as certain requirements and criteria must be met in order for a prior authorization request to be approved.
Any prescription over $500 requires a prior authorization, even if the medication is on the Advanced Health Formulary.
Advanced Health is a mandatory generic plan, therefore, generic medications must be used when commercially available.
Mental Health medications are covered directly by the State Medical Assistance Program (MAP, previously known as the Division of Medical Assistance Programs or DMAP) as part of the mental health (or 7/11) carve-out.
Please contact Advanced Health Customer Service at (541) 269-7400 if you have any questions or need assistance.