Oregon

State of Hepatitis C
Medicaid Access:

A-

Oregon

Liver damage (Fibrosis) restrictions

Fee-For-Service (FFS) and most MCOs do not impose liver damage restrictions. Advanced Health, AllCare CCO, Columbia Pacific CCO, Health Share, InterCommunity Health Network CCO, Jackson Care Connect, PacificSource Community Solutions CCO, Trillium Community Health Plan, and Umpqua Health Alliance follow the FFS criteria. Cascade Health Alliance, Eastern Oregon CCO, PrimaryHealth, and Yamhill Community Care do not provide hepatitis C coverage requirements publicly.

Sobriety restrictions

FFS and most MCOs do not impose sobriety restrictions. Advanced Health, AllCare CCO, Columbia Pacific CCO, Health Share, InterCommunity Health Network CCO, Jackson Care Connect, PacificSource Community Solutions CCO, Trillium Community Health Plan, and Umpqua Health Alliance follows the FFS criteria. Cascade Health Alliance, Eastern Oregon CCO, PrimaryHealth, and Yamhill Community Care do not provide hepatitis C coverage requirements publicly.

Prescriber restrictions

FFS does not impose prescriber restrictions except for patients with cirrhosis (F4), for which a specialist must be consulted. Advanced Health, AllCare CCO, Columbia Pacific CCO, Health Share, PacificSource Community Solutions CCO, Trillium Community Health Plan, and Umpqua Health Alliance follows the FFS criteria. InterCommunity Health Network CCO and Jackson Care Connect require a specialist to consult. Cascade Health Alliance, Eastern Oregon CCO, PrimaryHealth, and Yamhill Community Care do not provide hepatitis C coverage requirements publicly.

Recommendations

  • Ensure parity across FFS and MCO programs and transparency regarding hepatitis C coverage
    criteria.

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