Date: November 5, 2018
To: All Medical Assistance Providers
Re: Hepatitis C Direct Acting Antiviral Criteria Update
The Department of Healthcare and Family Services (HFS) has revised its Hepatitis C Direct Acting Antiviral (DAA) criteria, effective with prior authorizations submitted on or after November 1, 2018.
Based on additional guidance from the Food and Drug Administration (FDA) and the federal Centers for Medicare and Medicaid Services (CMS), additional scientific publications and accumulated clinical experience with the DAAs, HFS will now cover DAA therapy for Hepatitis C regardless of a patient’s Metavir score. Additional changes were made to the criteria, and it can be reviewed in its entirety at HFS Drug Prior Approval Criteria and Forms webpage.
The DAA Prior Authorization Request Form is being revised to reflect the new criteria. It will be posted to the HFS Drug Prior Approval Criteria and Forms webpage when it is finalized. Until such time, providers should continue to use the existing form.
Teresa T. Hursey