Gender dysphoria: Working with our experts

by Cory Bradley, PharmD

CareOregon is pleased to share that we have been working with Health Share of Oregon and local gender dysphoria expert physicians to update coverage principles. While CareOregon has covered a large number of therapies for this population for many years, this was a new opportunity to look at ways to lower the barriers even more. This includes reducing some prior authorization (PA) requirements for higher value drugs (Vantas), expanding quantity limits to allow for higher doses of hormone replacement products without needing a prior authorization, and reduction of administrative burden on certain PA criteria. 

CareOregon has been working to engage in a number of fields to help balance clinical expertise, evidence and drug costs to create a fair and balanced approach to the formulary. We know that prior authorization requirements can be burdensome and drive provider satisfaction, but it remains a helpful tool to promote the cost-effective use of our state’s limited Medicaid dollars.

In addition to working with the specialists in gender-affirming care, we have also recently worked with a group of pulmonologists on pulmonary arterial hypertension (PAH), cardiologists on heart failure, and are actively engaging with a local diabetes specialist to review our diabetes treatment pathway.