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New Texas Hepatitis C Treatment Coverage and PDL Update Scheduled for January 1, 2023 - Prior Authorization Not Required, Drug Screening Not required
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Last updated on 12/13/2022
Beginning January 1, 2023, Texas Medicaid will designate one medication as the primary preferred direct-acting antiviral (DAA) drug option for treating hepatitis C infection. The Texas Health and Human Services Commission (HHSC) will designate all other DAA drugs on the Medicaid formulary as nonpreferred. Also, HHSC will retire the following two clinical prior authorization forms for hepatitis C treatment agents:
•Antiviral Agents for Hepatitis C Virus - Initial Request (HHS Form 1335)
•Antiviral Agents for Hepatitis C Virus - Initial Request - Addendum (HHS Form 1342)
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. 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, 2023, to designate preferred and nonpreferred 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:
The U.S. Centers for Disease Control and Prevention (CDC) recommends hepatitis C screening at least once in a lifetime for all adults at least age 18 years and older, as well as all pregnant women during each pregnancy unless the prevalence of hepatitis C infection is less than 0.1% in a given setting. The CDC also recommends periodic testing for hepatitis C for all persons with risk factors while risk factors persist.
Additionally, the CDC indicates that clients might be reluctant to disclose stigmatizing risks, and any person who requests hepatitis C testing should receive it regardless of disclosure. Providers are encouraged to discuss treatment options for hepatitis C when they communicate positive test results to Medicaid clients.
For any nonpreferred DAA drugs, HHSC will continue to apply PDL prior authorization criteria for all Medicaid fee-for-service and managed care clients. Providers may reference the prior authorization criteria within the PDL on the Vendor Drug Program website.
Email vdp-formulary"at"hhsc.state.tx.us
with comments or questions.
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