Provider updates

Updated 5/28/26

CareOregon is transitioning pharmacy Prior Authorization processing and pharmacy call center services to OptumRx for CareOregon/Health Share, Jackson Care Connect, Columbia Pacific CCO and CareOregon Advantage, effective July 1, 2026.

Effective July 1, 2026, here is what you need to know

• Visit professionals.optumrx.com for information on how to:
  • Submit and track prior authorizations
  • Access forms and reference materials
  • Verify eligibility and pharmacy benefits
• Existing pathways for submitting prior authorizations will remain available during this transition. We recommend providers review and adopt the submission pathways listed on the site above, including:
  • Electronic Prior Authorization. Recommended for faster determinations and can be submitted through ePA vendors like Surescripts, CoverMyMeds, Veridigm, Cencora, and Arrive Health.
• Fax Submissions. The CareOregon fax number will remain the same. Updated fax forms can be found at the website listed above.

What is not changing

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

• All prior authorization 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 additional support available through OptumRx
• Pharmacy calls will be answered by OptumRx for CareOregon/Health Share, Jackson Care Connect, Columbia Pacific CCO and CareOregon Advantage 

Why this change is happening

This change aims to ensure long-term scalability, modernization, and operational sustainability as prior authorizations volume and clinical complexity continue to grow. This partnership allows us to access advanced automation, electronic prior authorization (ePA) connectivity, and technology tools that improve provider experience and accelerate members’ access to treatment—while retaining full clinical oversight.  

For additional help

For questions, please call our Pharmacy team at 503-416-4100 then follow prompts for option 3 (provider) and option 3 (pharmacy).   

For CareOregon Advantage questions please call 503-416-4279 then follow prompts for option 4 (provider) and 2 (pharmacy).

More information on ePA changes: link.careoregon.org/optum-rx-e-pa-guide
How to submit an ePA: business.optum.com/en/pharmacy-services/electronic-prior-authorization.html  

For information on how to navigate the OptumRx website: optumrx-provider-tools-where-to-start-and-how-to-navigate_external.pdf