iconstar paper   Hepatitis C Articles (HCV)  
Back grey arrow rt.gif
 
 
Florida-Medicaid HCV Criteria/Sovaldi .....August 8, 2014 pdf attached
 
 
  Sovaldi criteria pdf:
 
http://ahca.myflorida.com/Medicaid/Prescribed_Drug/drug_criteria_pdf/Sovaldi_Criteria.pdf
 
Download the PDF here
 
Excerpts:
 
for Gt1
 
1 - Prescribed by a hepatologist, gastroenterologist, infectious disease specialist or transplant physician
 
2 - Patient has abstained from the use of illicit drugs and alcohol for a minimum of one month as evidenced by negative urine or blood confirmation tests collected within the past 30 days, prior to initiation of therapy (results must be submitted with request);
 
If the test results submitted is positive the reviewer must review claims history or medical records to determine if medications are prescribed. If so proceed to next step (#5).
 
OR
 
Patient is receiving substance or alcohol abuse counseling services or seeing an addiction specialist as an adjunct to HCV treatment and it is documented in the medical records;
 

 
3 - HCV & HCV/HIV-1 Co-Infection - Genotype 1 or 4 (Interferon Ineligible)
 
Evidence of Stage 3 or Stage 4 hepatic fibrosis including one of the following:
 
· Liver biopsy confirming a METAVIR score of F3 or F4; OR
 
· Transient elastography (Fibroscan) score greater than or equal to 9.5 kPa; OR
 
· FibroTest score of greater than or equal to 0.58; OR
 
· APRI score greater than 1.5; OR
 
· Radiological imaging consistent with cirrhosis (e.g., evidence of portal hypertension); OR
 
· Physical findings or clinical evidence consistent with cirrhosis as attested by the prescribing physician.
 

 
4 - For HIV-1 co-infected patients, patients must have the following:
 
· Documented HIV-1 diagnosis, AND
 
· CD4 count greater than 500 cells/mm3, if patient is not taking antiretroviral therapy; OR
 
· CD4 count greater than 200 cells/mm3, if patient is virologically suppressed (e.g., HIV RNA < 200 copies/mL)
 
5 - Lab results (HCV RNA) collected two or more weeks after the first prescription fill date must indicate a response to therapy (≥ 2 log reduction in HCV RNA or HCV RNA < 25 IU/ml). Copy of results must be submitted.
 
a. Subsequent reauthorization is contingent upon subsequent HCV viral load results

 
 
 
 
  iconpaperstack View Older Articles   Back to Top   www.natap.org