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Oregon Health Authority: Oregon Health Plan Temporary Rule Filings (OAR chapter 410) · May 1, 2026 · Primary source

141-3855-050126.pdf: OAR 410-141-3855 amended to adopt the new High-Cost Drug Carve-Out List effective May 1, 2026.

Score 60PRIMARYregulatoryState registerOR

Summary

Oregon Health Authority issued a temporary administrative order effective May 1, 2026 through October 27, 2026 amending OAR 410-141-3855 to add six new drugs to the High-Cost Drug Carve-Out (HCDCO) List and codify a quarterly update cadence for the list. The six new drugs, including tividenofusp alfa, leniosilib, marnetegragene autotemcel, doxecitine and doxribtimine, pegzilarginase, and copper histidinate, each cost $500,000 or more per member per year and treat rare conditions with few alternatives. Beginning May 1, 2026, these drugs are carved out of CCO capitation and covered by OHA directly on a fee-for-service basis.

What this may mean

Oregon CCOs are relieved of capitation-based financial responsibility for the six newly added drugs effective May 1, 2026, with OHA assuming direct FFS coverage and prior authorization review for those treatments. CCOs retain responsibility for associated care coordination, drug administration, inpatient stays, and transportation for members receiving HCDCO drugs. The rule also establishes a standardized quarterly timeline governing when CCOs may request additions or removals from the HCDCO List, with effective dates tied to request submission windows.

Informational only. Not legal, medical, financial, or other professional advice. Always consult a qualified professional familiar with your specific facts before relying on any item.

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