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.