Oregon

State of Hepatitis C
Medicaid Access:

A-

Oregon

Liver damage (Fibrosis) restrictions

Fee-For-Service (FFS), Advanced Health, AllCare Health, Cascade Health Alliance, Columbia Pacific CCO, Eastern Oregon CCO, Health Share of Oregon/Care Oregon, Jackson Care Connect, PacificSource Community Solutions, Trillium Community Health Plan, and Umpqua Health Alliance do not impose liver damage restrictions. Yamhill Community Care does not provide hepatitis C coverage requirements publicly.

Sobriety restrictions

FFS, Advanced Health, AllCare Health, Cascade Health Alliance, Columbia Pacific CCO, Eastern Oregon CCO, Health Share of Oregon/Care Oregon, Jackson Care Connect, PacificSource Community Solutions, Trillium Community Health Plan, and Umpqua Health Alliance do not impose sobriety restrictions. Yamhill Community Care does not provide hepatitis C coverage requirements publicly.

Prescriber restrictions

FFS, Advanced Health, AllCare Health, Cascade Health Alliance, Columbia Pacific CCO, Eastern Oregon CCO, Health Share of Oregon/Care Oregon, Jackson Care Connect, PacificSource Community Solutions, Trillium Community Health Plan, and Umpqua Health Alliance do not impose prescriber restrictions except for patients with cirrhosis (F4), for which a specialist must be consulted. InterCommunity Health Network CCO appears to require that treatment to be prescribed by or in consultation with a hepatologist, gastroenterologist, or infectious disease specialist. 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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