Hepatitis C Treatment Coverage and PDL Update Scheduled for Jan. 1

December 7, 2022

Beginning January 1, 2023, HHSC will designate one medication as the primary preferred direct-acting antiviral (DAA) drug option for treating Hepatitis C infection. 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. Additionally, any enrolled Medicaid provider 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 January 1 to designate preferred and non-preferred options for DAA treatment. Drugs identified on the PDL as preferred are available without prior authorization. The table below summarizes the national drug codes (NDCs) impacted by this change:

Name NDC January 1 PDL status
  • 00074260028
  • 00074262528
  • 61958220101
  • 61958220301
  • 61958220401
  • 61958220402
  • 61958220501
  • 61958220502
  • 61958240101

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. Additionally, effective January 1, the following clinical prior authorization forms for Hepatitis C treatment agents will be retired and are no longer necessary:

  • Antiviral Agents for Hepatitis C Virus – Initial Request (HHS Form 1335)
  • Antiviral Agents for Hepatitis C Virus – Initial Request – Addendum (HHS Form 1342)