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.
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: email@example.com.