Referring Patients with Crohn's Disease or Ulcerative Colitis for Biologic Infusion in Oregon

If your GI practice treats patients with Crohn's disease or ulcerative colitis, you know the moment well. The diagnosis is in, the oral and injectable therapies have run their course, and it is time for a biologic infusion. What should feel like a clear next step often becomes a paperwork project, especially when Medicare or Medicare Advantage is in the mix.

Vital Care of Portland works with GI offices across Oregon to make that handoff simple. This guide walks through the biologic infusion therapies we dispense for IBD, what our intake process looks like for your referral coordinators, and how we handle Medicare and Medicare Advantage coverage for the growing share of IBD patients over 65.

Biologic infusion therapies we dispense for Crohn's and UC

Vital Care of Portland is a full-scope infusion pharmacy for the current biologic toolkit in IBD, including:

•       Tremfya (guselkumab) for moderate to severe ulcerative colitis and Crohn's disease

•       Skyrizi (risankizumab) for moderate to severe Crohn's disease and ulcerative colitis

•       Entyvio (vedolizumab) for moderate to severe Crohn's disease and ulcerative colitis

•       Remicade (infliximab) and infliximab biosimilars including Inflectra, Avsola, and Renflexis

•       Stelara (ustekinumab) for moderate to severe Crohn's disease and ulcerative colitis

We also accept open physician orders for additional therapies where clinically indicated.

How the referral process works, step by step

From the moment a referral lands in our intake queue, our goal is to move the patient to a first infusion within two to three weeks. For most of our GI referrals, we see an even faster turnaround when the clinic sends the prescription, recent encounter notes, labs and diagnostic results together. Here is what happens on our side:

1.     Referral received by fax at 971-484-4950 or electronically through our intake process.

2.     Welcome call from our pharmacy technician team within one business day to introduce the patient to Vital Care and confirm contact preferences.

3.     Benefits investigation across medical and pharmacy benefits, including Medicare Part B, Mediare Part D, Medicare Advantage, and commercial plans.

4.     Prior authorization coordinated end-to-end by our team. We handle the letter of medical necessity language, supporting documentation, and appeal if needed with the clinic’s input and sign-off.

5.     Patient assistance enrollment for eligible patients, including manufacturer copay programs and independent foundation support for Medicare patients who cannot use copay cards.

6.     Scheduling and site-of-care decision: home infusion with one of our nurses, or our private infusion suite in Happy Valley.

7.     Communication back to the referring clinic at each milestone so your MA team is never chasing us for updates.

Medicare and Medicare Advantage coordination for IBD patients

The demographic in IBD is shifting. Elderly-onset and long-standing IBD in Medicare-age patients are both growing categories, and biologic therapy for these patients is increasingly common. Coverage, however, is more nuanced than a commercial plan.

Here is how we approach it:

• For Medicare Part B patients, we confirm whether the therapy bills under the medical benefit (infliximab and most in-office infused biologics) and coordinate with the patient's supplement or Medigap plan for the coinsurance portion.

• For Medicare Advantage patients, we verify the specific MA plan's formulary placement for Entyvio, Stelara, Tremfya, Skyrizi, and infliximab products, and we pursue prior authorization within the plan's network pathway.

• For dual-eligible patients, we identify the Medicaid wrap-around and coordinate with the state Medicaid contractor so the patient's out-of-pocket is accurate before the first infusion.

• For patients whose insurance plan requires step therapy, we document prior trial and failure of required agents and we advocate for exceptions where clinically appropriate.

The practical effect is that your referral coordinator does not need to become an expert in insurance formularies to send a patient to us. Our team takes the plan details and runs.

Site of care: home or the Happy Valley infusion suite

Many of our IBD patients prefer home infusion. Home is quieter, more private, and easier to fit into a work schedule. For patients who want to be seen in person, our Happy Valley infusion suite offers a private room, recliner, warm blanket, snacks and Wi-Fi.

Either way, the same team handles everything from prior auth to the chair. That continuity is a big part of why referring offices tell us their IBD patients stay on therapy.

How to refer a patient

If you would like to refer a Crohn's disease or ulcerative colitis patient for biologic infusion, our Oregon account team is ready to help. Fax a referral directly to 971-484-4950. Our intake team will confirm receipt and begin benefits investigation the same day.

For general questions, call 971-484-4940 or email intake@vitalcareofportland.com.