Changes to Hepatitis C Prior Authorization Criteria Begin Sept. 1

Published on
June 29, 2021

Beginning September 1, 2021, Medicaid will expand coverage of the Hepatitis C virus clinical prior authorization criteria to include all metavir fibrosis scores.  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.