Provider Alert! Hepatitis C Treatment Coverage and PDL Update Delayed to Jan. 1, 2023

Date: September 12, 2022

Attention: All Providers 

Effective Date: September 1, 2022

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with 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: Texas Children’s Health Plan (TCHP) would like to inform providers that on 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 Health and Human Services Commission (HHSC) will designate all other DAA drugs on the Medicaid formulary as non-preferred.

How this impacts providers: On January 1, 2023, HHSC will publish an update to the Texas Medicaid Preferred Drug List to designate preferred and non-preferred options for DAA treatment. 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.

Additionally, effective January 1, 2023 the following clinical prior authorization forms for Hepatitis C treatment agents will be retired and 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)

Next steps for providers: Prescribers should share this communication with their staff.

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
http://www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.