Provider Alert! Changes to Hepatitis C Prior Authorization Criteria
Date: July 14, 2021
Attention: Primary Care Providers
Effective Date: September 1, 2021
Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.
Call to action: Effective September 1, 2021, Medicaid will expand coverage of the Hepatitis C virus clinical prior authorization criteria to include all metavir fibrosis scores.
How this impacts providers: The Texas Health and Human Services Commission (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.
- A drug screening will no longer be required.
Next steps for providers: 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, 2021. Revised prior authorization forms will be available beginning September 1, 2021.
Resource:
https://txstarchip.navitus.com/pages/prior-authorization-forms.aspx
Prescribing provides must enroll with Medicaid for the prescription to be eligible for fee-for-service reimbursement.
If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.
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