The Oregon Health Authority (OHA) has been providing financial support to Medicaid members by covering the full treatment costs of their Hepatitis C medications. This is only possible through their risk corridor for Hepatitis C medications, which entails extensive case management. PacificSource Community Solutions and its members are included in this benefit, since it translates to enhanced care for our patients. However, to continue receiving support, health plans need to follow OHA’s rules for case management.
OHA’s rules are as follows:
- Adequate access to prescribers and treatment without unreasonable delay
- Expectation that a care management team, or case manager, is assigned to the member for the duration of the treatment and will evaluate if additional support is required
- Check on appropriate billing (e.g. churn or switch to TPL, quantity, and NDC included on medical claims)
- Medication Reconciliation; Check on drug-drug interactions
- Coordinate with patient, PCP, prescriber, and pharmacy regarding treatment
- Prevent gaps in medication supply and ensure refills are accessed in timely fashion
- Contact the patient prior to initiating treatment and as frequently as needed to ensure compliance, access to refills, and collection of 12 week SVR
- Ensure compliance with viral load testing and reporting:
- 12 weeks post-completion SVR
- 24-week post-treatment completion is strongly recommended to confirm the value of DAA medications to prevent relapse
- Provide education for patient and PCP as needed
- Warm hand-off documented in case of eligibility/enrollment changes (churn)
- Transition to complex or chronic illness case management, if needed
As a healthcare provider, you can contribute to your patient’s success with their Hepatitis C treatment by ordering their viral load 12 and 24 weeks post-treatment. PacificSource Community Solutions appreciates your continued support in helping our members achieve better outcomes.