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Reminder of Hepatitis C Coverage

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The Texas Health and Human Services Commission (HHSC) encourages Medicaid providers to evaluate patients who are at risk for the hepatitis C virus (HCV) to assess whether they would benefit from treatment.

The Centers for Disease Control (CDC) recommends that all adults be screened for HCV at least once in a lifetime and that people with certain risk factors test once a year. Chronic HCV can result in serious, even life-threatening health problems like cirrhosis and liver cancer. HCV screening is important, as it can save and prolong life.

Mavyret (Glecaprevir/Pibrentasvir)

The preferred direct-acting antiviral (DAA) agent for HCV is Mavyret (glecaprevir/pibrentasvir).

Mavyret (glecaprevir/pibrentasvir) is an oral prescription medication for adults and children three years of age or older with chronic HCV genotypes 1–6. In most cases, the treatment regimen is three pills taken once daily for eight weeks.

Mavyret (glecaprevir/pibrentasvir) does not require clinical prior authorization when prescribed following the U.S. Food and Drug Administration (FDA) labeling.

Note: Prior authorization is required for non-preferred agents.

All prescribing providers can prescribe this treatment to their patients with HCV. HHSC allows prescribers to write prescriptions for the entire course of therapy.

Prescribers may also have the client return for further testing if warranted.

Quantity Limits for Hepatitis C Direct-Acting Antiviral Prescriptions

Prescribers can write prescriptions for a client’s entire hepatitis C treatment course. This improves access and adherence to therapy, as clients do not need to request additional refills throughout their treatment duration. This applies to all hepatitis C direct-acting antiviral medications for the Medicaid program.

Refer to the “Hepatitis C Direct-Acting Antiviral Treatment Products” section in the Outpatient Drug Services Handbook of the Texas Medicaid Provider Procedures Manual for more information.

Email vdp-policy@hhs.texas.gov with any comments or questions.