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Changes to Hepatitis C Prior Authorization Criteria September 1, 2021

Last updated on 6/30/2021

Beginning September 1, 2021, Medicaid will expand coverage of the Hepatitis C virus clinical prior authorization criteria to include all metavir fibrosis scores. The Texas Health and Human Services Commission (HHSC) will modify the requirements as follows:

  • Treatment with a direct-acting antiviral (DAA) medication on the formulary will be available to Medicaid clients regardless of metavir fibrosis scores.
  • HHSC no longer restricts the prescribing of a DDA medication to a specialist provider. These medications can now be prescribed by general practitioners as well.
  • A drug screening will no longer be required.

HHSC requires the clinical prior authorization criteria for all Medicaid clients, both fee-for-service and managed care.

Providers should continue using the current criteria and forms until August 31. Revised prior authorization forms will be available beginning September 1, 2021.

Prescribing provides must enroll with Medicaid for the prescription to be eligible for fee-for-service reimbursement.

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