Attention: Sublocade and Brixadi update
September 1st, 2024: long-acting buprenorphine injections (Sublocade and Brixadi) are now covered on the pharmacy benefit for OHP without a prior authorization. This means Sublocade and Brixadi can be dispensed at pharmacies instead of only being available through buy-and-bill. Sublocade and Brixadi are still covered through buy-and-bill without a prior authorization. When dispensed from a pharmacy, Sublocade and Brixadi have quantity limits that must be met. If prescriptions are written for incorrect quantities and/or day supplies, claims may not pay. If these quantity limits need to be exceeded, a prior authorization is required. Please refer to the FDA labeling for Sublocade and Brixadi for dosing.
Quantity Limits:
Sublocade (FDA Label)
- 300mg dose: 300mg every 4 weeks (1.5 mL every 4 weeks)
- 100mg: 100mg every 4 weeks (0.5 mL every 4 weeks)
Brixadi (FDA Label)
- 8mg weekly dose: 8mg every 7 days (0.16mL every 7 days)
- 16mg weekly dose: 16mg every 7 days (0.32mL every 7 days)
- 24mg weekly dose: 24mg every 7 days (0.48mL every 7 days)
- 32mg weekly dose: 32mg every 7 days (0.64mL every 7 days)
- 64mg monthly dose: 64mg every 4 weeks (0.18mL every 4 weeks)
- 96mg monthly dose: 96mg every 4 weeks (0.27mL every 4 weeks)
- 128mg monthly dose: 128mg every 4 weeks (0.36mL every 4 weeks)
Drug list (Formulary)
Bi-Mart Pharmacy closure: Click here to read more.
The drug list (or formulary) is a directory of all preferred medications approved for Jackson Care Connect members. This list is administered and provided by CareOregon. To download and view the drug list, click on the link or thumbnail below.
2024 Jackson Care Connect OHP Drug List (Formulary)
Download a machine-readable format (JSON) of the Formulary
You can search for a drug in one of the following ways:
- Find the drug listed in the formulary/PDF index.
- In the PDF file, enter the drug name into the search box located in the menu.
- Call Customer Service for assistance in finding a drug.
Formulary updates
Jackson Care Connect makes formulary updates when necessary. These usually occur monthly.
- Formulary Update (PDF, updated October 1, 2024)
- Formulary Updates - New Generics (PDF, effective October 1, 2024)
- CareOregon (OHP) and CareOregon Advantage (Medicare) - Vaccine Coverage Guide
Policies: Pharmacy
Forms: Pharmacy
- Prior Authorization and Formulary Exception Request form (OHP only)
- Injectable Medication Administered by Provider Authorization form
- Hospice Prior Authorization form
- Hepatitis C Prior Authorization Request form (OHP only)
- Nutritional Supplement Medication Request form
- Pharmacy Provider Reconsideration Request form
Policy updates and other forms: Pharmacy
- Authorization Policy-Injectables/Medications Administered Under the Medical Benefit (Updated 10/2024)
- Authorization Guidelines - Injectable Drugs for Bleeding and Clotting Disorders (Updated 3/2024)
- HepC DUR Provider Update
Electronic prior authorization Q&As
Treatment Pathways