Provider updates

Changes to the Columbia Pacific CCO Oregon Health Plan (Medicaid) Formulary

Effective January 1, 2023 most hepatitis C treatments will be covered by Oregon Medicaid (including all CCOs) without requiring prior authorization. Two conditions must be met for this to apply 1) the member must be treatment naïve; AND 2) an Oregon Health Plan preferred drug (Mavyret or generic Eplcusa) is being used within usual quantity limits.

Preferred Hepatitis C Drugs

• Mavyret - Most situations clinically only require 8 weeks. Up to 16 weeks is available without PA.
• Generic Epclusa - Most situations clinically only require 12 weeks, but up to 24 can be received without PA.

Definition of Treatment Naïve

• The claims system will look for any evidence of a previous course of therapy with a protease inhibitor.
• Note: In some cases (such as reinfection or limited first treatment course), it may be clinically appropriate for a second course to be approached as treatment naïve. However, prior authorization will be required if claims see a past treatment.

Case Management

• Will be required if PA is required (optional if PA is not needed). Use the Hepatitis C Prior Authorization Request form, which can be found under the Pharmacy Resources page on our website.
• Use the Hepatitis C Case Management Request form for optional case management requests. This form is also available under Pharmacy Resources.

Your office should have received a fax from Columbia Pacific regarding the above information. If you did not receive it, you can download it here. 

• No Prior Authorization Required for most Hepatitis C medications