Skip to content
How-to · Health care

Resolve an OHP pharmacy payment or coverage problem

If a pharmacy asks you to pay for an OHP prescription, check who was billed and whether the drug needs prior authorization before you pay.

Steps

6 steps
  1. Ask if the pharmacy billed OHPYour CCO pays for most prescriptions. OHA pays for some mental health drugs and for members not in a CCO.
  2. If you have Medicare, ask about Part DMedicare Part D pays first for drugs it covers.
  3. Give the pharmacy all your coverageGive the pharmacy every plan you have, including private insurance.
  4. Ask about prior authorizationYour prescriber may need to ask your CCO or OHA to approve the drug.
  5. Can't wait? Use an Agreement to PayYou pay now and the pharmacy pays you back if the drug is approved later.
  6. Appeal if you think OHP should payAsk your CCO for an appeal first, then ask OHA for a hearing if needed.

Bring

  • Picture ID
  • All your health coverage ID cards
If you signed an Agreement to Pay for a prescription, you do have to pay for it.

More health care how-tos

  • How-to

    Apply for iCanConnect deafblind communication equipment

    Health care
    1. Get the 2026 Oregon applicationUse the fillable English 2026 form on the Oregon iCanConnect page. A Word version is also listed.
    2. Fill out sections 2 to 5Personal data, program goals, income eligibility and your signed attestation. Someone else may fill it in for you.
    3. Show your income is under the limitSend proof you are in a qualifying federal program such as Medicaid or SSI, or proof of all household income.
    + 2 more steps in the full guide
    BringProof of qualifying benefits or incomeProfessional's disability attestationIEP or Social Security letter
    Access Technologies, Inc. (iCanConnect Oregon)503-361-1201
    Full guideOfficial page
  • How-to

    Apply for in-home care help (OPI, OPI-M or Medicaid)

    Health care
    1. Learn which programs fitStart by learning about the programs you might qualify for, then apply.
    2. For Medicaid long-term servicesOlder adults and people with physical disabilities contact an Area Agency on Aging or APD office.
    3. For Oregon Project Independence (OPI)OPI has no income or asset limits. You pay part of the cost on a sliding scale.
    + 1 more step in the full guide
    CostOPI: you pay part of the cost on a sliding scale
    ODHS Aging and People with Disabilities855-673-2372
    Full guideOfficial page
  • How-to

    Apply for OHP Young Adults with Special Health Care Needs

    Health care
    1. Check that you meet both rulesAges 19 to 21, a qualifying health need that began before age 19, and income up to 205% of the federal poverty level.
    2. Apply for OHP onlineUse the Oregon ONE website. You can apply any time.
    3. Answer the special health needs questionsYoung adults complete a short set of questions in the OHP application to qualify.
    + 1 more step in the full guide
    CostEarly and Periodic Screening, Diagnostic and Treatment (EPSDT) is at no cost
    Oregon Health Authority (Oregon Health Plan)800-699-9075
    Full guideOfficial page