Fee-for-service (FFS) Pharmacy Benefit Update Project Work Plan
Last updated: 2/13/2025
As part of the Benefit Update Project, the Oregon Health Authority is evaluating select services that are not currently funded by the Oregon Health Plan. These topics are being reviewed to see if drug coverage should be modified after 1/1/2027. The summary below is a list of topics that are tentatively scheduled for review at the fee-for-service (FFS) Pharmacy and Therapeutics (P&T) Committee as part of this project. They are provided as a convenient reference tool and are not comprehensive list. For additional information on this project see the Health Evidence Review Commission (HERC) website.
| Unfunded diagnosis | Tentative FFS P&T Review Date |
| Irritable bowel syndrome, constipation | February 2025 |
| Anal fissures | April 2025 |
| Hyperhidrosis | April 2025 |
| Molluscum contagiosum | June 2025 |
| HIV-related lipodystrophy | June 2025 |
| Fibromyalgia, chronic pain conditions | June 2025 |
| Chronic spontaneous urticaria, moderate-severity inflammatory skin disease | June 2025 |
| Dry eye disease | June 2025 |
| Actinic keratosis | August 2025 |
| Mild-moderate acne, rosacea | August 2025 |
| Mild-moderate inflammatory skin conditions | October 2025 |
| Allergic rhinitis | October 2025 |
| Topical fungal infections | October 2025 |
| Excessive daytime sleepiness related to shift work disorder, chronic fatigue | December 2025 |
| Herpes simplex virus infection | December 2025 |
| Dysmenorrhea | December 2025 |
| Muscle spasm, chronic pain | 2026 or as needed |
| Restless leg syndrome | 2026 or as needed |
| Chronic cough, upper respiratory infections | 2026 or as needed |
Notes/Disclaimers:
- The proposed schedule outlines when clinical evidence for medications may be reviewed at the FFS P&T committee. The P&T Committee will not evaluate total cost of treating the unfunded condition.
- Dates are tentative and may change at any time without notice depending on priorities of the Oregon Health Authority.
- See the P&T website for draft and final meeting materials and posting dates. Draft documents are open for public comment and posted 45-60 days in advance of the meeting.
- Drugs will be included in the review if they have the FDA indication for the unfunded diagnosis.
- See the searchable PDL for current FFS criteria.