For Referring Physicians
Thank you for the opportunity of caring for your patients. We’re here to help you with your care decisions, and appreciate working with you to determine the proper course of care for your patients. We respect the confidence you place with us, and welcome your input to better serve you.
To Referring Providers who care for patients with Hepatitis C,
Given the advent of highly effective oral therapy for all genotypes of Hepatitis C, there has been a tsunami of interest in pursuing treatment resulting in a high number of referrals to Eugene Gastroenterology Consultants to the point of impeding access to our office for all patients. As you know, while the completely oral therapies are highly effective and cause few side effects, the cost of therapy is exorbitantly high (minimum of $80,000 per treatment course).
Insurance coverage for Hepatitis C treatment is therefore contingent on patients meeting certain criteria: Evidence of active infection with documented viremia and known genotype; documentation of Fibrosis score of 3 or 4 on liver biopsy (or FibroSpect blood testing); absence of active use of alcohol and recreational drugs; and reliable compliance with medical treatment.
Before scheduling any patients to our office for Hepatitis C treatment considerations, we are now mandating the following testing to be performed by your office:
- Routine labs of complete blood count (CBC), comprehensive metabolic panel (CMP), prothrombin time (PT), Hepatitis A and B immunity, HIV testing, and urine toxicology screen (to include assessment for drugs of abuse and alcohol)
- Hepatitis C specific labs of genotype and quantitative Hep C RNA (viral load)
- Assessment of degree of hepatic fibrosis with either percutaneous liver biopsy or FibroSpect blood testing; must show level 3 – 4 fibrosis in order to be considered an appropriate candidate for treatment
- Imaging of the liver with either abdominal ultrasound and/or CT scan and/or MRI. For routine testing, ultrasound is sufficient in most cases.
Please be advised that all the above testing is required to be completed with results forwarded to us for review before we will schedule any appointment. All requests for consultation for Hepatitis C treatment without the above documentation will be returned for completion. No appointments will be scheduled until all the above test results are available.
In addition to the above testing, patients with Hepatitis C must discontinue all alcohol consumption completely for at least 6 consecutive months. Treatment will not be considered for anyone with ongoing alcohol or drug use.
This policy will be effective August 1, 2015. We fully recognize the increased burden this will place on your office, but find this necessary to ensure optimal and timely care for all our patients. Please contact our office manager, Angela Wilson, or any of the providers of EGC at 541-868-9500 if you have any questions or concerns.
The Providers of Eugene Gastroenterology Consultants, PC