Committee advances OHA proposal to remove limits on coverage for hepatitis C treatment

Yesterday the Oregon Drug Use Review/Pharmacy & Therapeutics (P&T) Committee, which advises the Oregon Health Authority on prescription drug coverage, recommended a change in prior authorization criteria which will expand treatment access to all Oregon Health Plan (OHP) patients with chronic hepatitis C, without fibrosis restrictions.

“I look forward to approving this recommendation to expand treatment coverage for OHP members,” said OHA Director Patrick Allen. “Oregon has the highest mortality rate associated with hepatitis C in the country. We have an opportunity to eliminate hepatitis C in our state, and this is a key strategy to get us there.”

Chronic hepatitis C infection is the leading cause of complications from chronic liver disease, including cirrhosis, liver failure, and liver cancer. People with hepatitis C often show no symptoms. Patients can unknowingly have the disease for decades before it becomes problematic, and sometimes it remains asymptomatic and only a screening test identifies the presence of the virus.

Hepatitis C is most common in the baby-boom generation, which has the highest burden of the consequences of chronic infection, such as liver cancer and death.

Over the past year OHA has been taking steps to expand treatment coverage, and the P&T Committee has been continually monitoring the coverage criteria and emerging evidence on hepatitis C treatment.

The P&T Committee initially prioritized treatment for patients in greatest need of treatment. Policies in place approve treatment for patients with fibrosis stage 2 (F2) or greater, and all stages for individuals with HIV co-infection.

In September the P&T Committee recommended an update to the prior authorization requirement. It would remove the active treatment requirements for those with substance use disorder (SUD) and incorporate the necessary additional support into case management programs. This means the requirement that patients must be in active SUD treatment will be removed by January 1, 2019.

OHA is requesting a total of $107 million for the 2019 biennium, $10 million of which is state General Funds, to support the ongoing cost of treatment expansion. The agency request was funded in Governor Kate Brown’s proposed budget, which was released November 28.

The P&T recommendations head to OHA Director Allen for approval. The agency will then enter a 60-day notification period, with an expected implementation date of March 1.

This press release was produced by the Oregon Health Authority