Read more: Members may have trouble getting meds at some pharmacies.

Select language

Read more: Change Healthcare Cyber Security Issue FAQs

Provider updates

No Prior Authorization Required for Most Hepatitis C Medications

Dec 16, 2022, 21:14 PM

Changes to the CareOregon 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

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

Website feedback

close icon

Help us improve our website

Having trouble finding what you’re looking for? Want to tell us about your website experience? Take our feedback survey and let us know!