Provider updates

CareOregon is transitioning pharmacy Prior Authorization (PA) processing and pharmacy call center services to OptumRx for all CareOregon CCOs and CareOregon Advantage, effective July 1, 2026. We’re sharing this update early to support our provider partners and ensure a smooth transition.

What is not changing

CareOregon will continue to make all key clinical and coverage decisions. This includes:

• All clinical criteria decisions
• All formulary and Pharmacy and Therapeutics (P&T) governance
• All medical prior authorization and appeals
• Oversight, auditing, and quality review of OptumRx operations

Providers will continue to have access to CareOregon clinical consultation, with OptumRx supporting administrative and operational functions.

Why this change is happening

Pharmacy PA volume and clinical complexity have grown rapidly and now require infrastructure that can scale at a larger level. Partnering with OptumRx allows CareOregon to access advanced automation, electronic PA (ePA) connectivity, and technology tools that improve provider experience and accelerate members’ access to treatment—while CareOregon retains full clinical oversight.

This approach supports long-term operational efficiency, allowing CareOregon to continue directing resources toward member services and community-based care.

Beginning July 1, 2026:

• Pharmacy calls will be answered by OptumRx for CareOregon/Health Share, Jackson Care Connect, Columbia Pacific CCO and CareOregon Advantage
• Pharmacy PAs for CareOregon members will be submitted through OptumRx 

Providers will see changes to PA submission workflows. Specific details and training resources will be shared later this spring. Our commitment is to ensure a smooth transition.

We know this has been a time full of change, and we sincerely appreciate your continued dedication to our members and your partnership as we navigate these changes together.   

For further questions please reach out to Provider Customer Service at 503-416-4100 or 800-224-4840. Press option 3 for provider.