OHP 3978 is the Oregon Health Authority's paper request for prior authorization of prescription drugs and oral nutritional supplements for fee-for-service (open card) Oregon Health Plan members. Prescribers send it, with the required documentation, to the Oregon Pharmacy Call Center when they cannot submit electronically. Reviewers apply the criteria in OHA's Oregon Medicaid PA Criteria guide.
The prescriber completes the request: provider name and NPI, client ID, treatment dates and diagnosis code, and the drug's name, strength and quantity. Section IV applies only to enteral, parenteral and IV products and oral supplements, and the Section V patient questionnaire only to supplements.
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Prior Authorization Request for Pharmacy and Oral Nutritional Supplements
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Prescribers requesting fee-for-service Oregon Health Plan coverage of a prescription drug or oral nutritional supplement. Members enrolled in a coordinated care organization use their CCO's pharmacy form. OHA also pays some drugs fee-for-service because they are carved out of CCO benefits; its quarterly Drug Carve-Out List shows which.
No. OHA's Prior Authorization Handbook says the pharmacy request does not require the MSC 3970 EDMS coversheet that medical and dental faxes need. It goes to the Oregon Pharmacy Call Center with the required documentation, and OHA describes it as the paper option for when an electronic submission is not possible.
OHA publishes its fee-for-service prior authorization criteria as the Oregon Medicaid PA Criteria guide, linked from the Pharmaceutical Services policy page alongside the form. Reviewing the criteria for the drug class before submitting helps the request include the clinical details the reviewer needs.