HHSC recently signed a settlement agreement related to Hepatitis C treatments. The agreement requires HHSC to revise its prior authorization criteria for direct-acting antiviral (DAA) treatment for clients with chronic Hepatitis C. The agreement further requires a class action notice to be mailed to all individuals currently enrolled in Medicaid diagnosed with Hepatitis C and who have not previously received DAA treatment through Medicaid.
Beginning September 1, 2021, HHSC will not include restrictions for access to DAA treatments based on a client’s fibrosis score (refer to the June 29 notice). A high-level summary of the changes include:
- Treatment with a DAA medication on the formulary will be available to Medicaid clients regardless of metavir fibrosis scores.
- The prescribing of a DAA medication is no longer restricted to a specialist provider. These medications can now be prescribed by general practitioners.
- A drug screening is no longer required.