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Colorado
Liver damage restrictions
Colorado Primary Care Case Management (PCCM) and Denver Health Medicaid Choice Managed Care Organization (MCO) do not impose liver damage restrictions. Rocky Mountain Health Plan does not publish hepatitis C clinical coverage criteria.
Sobriety restrictions
Colorado PCCM and Denver Health Medicaid Choice MCO do not impose sobriety restrictions. Rocky Mountain Health Plan does not publish hepatitis C clinical coverage criteria.
Prescriber restrictions
Colorado PCCM allows primary care providers who have received sufficient education to prescribe treatment, or treatment must be prescribed in consultation with an expert. Denver Health Medicaid Choice MCO requires a prescription to be written by or in consultation with a gastroenterologist, infectious disease, hepatologist or HIV specialist. Rocky Mountain Health Plan does not publish hepatitis C clinical coverage criteria.
Recommendations
- Remove prescriber requirements.
- Ensure transparency regarding hepatitis C coverage criteria and parity between PCCM and MCO programs.
- Remove prior authorization for patients who qualify for simplified treatment.
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