Hepatitis C Direct–Acting Antiviral Treatment Products
Medicaid clients are eligible for direct-acting antiviral (DAA) treatments for Hepatitis C infection. Clients do not have to meet specific METAVIR fibrosis scores, and HHSC does not require clinical prior authorization or illicit drug screenings. Any Medicaid-enrolled provider can prescribe DAA drugs.
HHSC partnered with AbbVie starting Jan. 1, 2023, to increase access to treatment. AbbVie’s product Mavyret is the Medicaid preferred DAA drug and is available without a preferred drug list (PDL) prior authorization. For any non-preferred DAA drugs, HHSC may continue to approve if the client meets at least one of the PDL prior authorization criteria . This applies to both fee-for-service and managed care. The PDL Criteria Guide explains the criteria used to evaluate the non-preferred prior authorization requests.
Refer to the VDP website Preferred Drug page to review the latest edition of the PDL for impacted drugs.
Prescribers may write prescriptions for the entire course of therapy, so clients do not need to request additional refills throughout their treatment duration. Prescribers may choose to write a prescription for the entire treatment cycle or have the client return for further testing if warranted. This quantity limit applies to all Hepatitis C DAA drugs.
Refer to the Formulary search and select “Hepatitis C Agents” from the “PDL Class” filter to identify these drugs.