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Beginning September 1, 2022, Texas Medicaid will designate one medication as the primary preferred direct-acting antiviral (DAA) drug option for treating a hepatitis C infection. The Texas Health and Human Services Commission (HHSC) will designate all other DAA drugs on the Medicaid formulary as non-preferred.
All Medicaid clients are eligible for DAA treatment with the primary preferred agent regardless of the client’s METAVIR fibrosis score, and prior authorization is not required. Any enrolled Medicaid providers can prescribe the preferred drug, and a drug screening is not required.
HHSC will publish an update to the Texas Medicaid Preferred Drug List (PDL) on September 1, 2022, to designate preferred and non-preferred options for DAA treatment. Drugs identified on the PDL as preferred are available without prior authorization.
The US Centers for Disease Control and Prevention (CDC) recommends hepatitis C screening at least once in a lifetime for all adults at least age 18 years and older as well as all pregnant women during each pregnancy unless the prevalence of hepatitis C infection is less than 0.1% in a given setting. Periodic testing for hepatitis C is also recommended for all persons with risk factors while risk factors persist. Additionally, the CDC indicates that there might be a reluctance to disclose stigmatizing risks, and any person who requests hepatitis C testing should receive it regardless of disclosure. Providers are encouraged to discuss treatment options for hepatitis C at the time that providers communicate positive test results to Medicaid clients.
For any non-preferred DAA drugs, HHSC will continue to apply PDL prior authorization criteria for all Medicaid clients, both fee-for-service and managed care. Providers may reference the PDL prior authorization criteria within the PDL on the Vendor Drug Program website.
Beginning September 1, HHSC will retire the following clinical prior authorization forms for hepatitis C treatment agents:
- Antiviral Agents for Hepatitis C Virus – Initial Request (HHS Form 1335)
- Antiviral Agents for Hepatitis C Virus – Initial Request – Addendum (HHS Form 1342)
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