Hepatitis C Treatment
| To: | All Medical Assistance Providers |
| Date: | September 30, 2016 |
| Re: | Hepatitis C Treatment |
The purpose of this notice is to inform providers that the cost of newer, direct-acting antivirals (DAAs) for treatment of Hepatitis C for Medicaid beneficiaries will be covered in earlier stages of the condition (F3) effective with dates of service on or after October 1, 2016.
The Centers for Disease Control and Prevention (CDC) and the United States Preventive Services Task Force recommend a onetime Hepatitis C Virus antibody test for those born between 1945 and 1965 regardless of risk factors. CDC estimates that a significant majority of those living with Hepatitis C belong to this age group and approximately three-fourths of Hepatitis C related deaths occur in this population. The Illinois Medicaid program allows and pays for Hepatitis C antibody testing when ordered by a physician or other authorized practitioner.
The DAAs have resulted in a significant shift in the general approach to treatment of Hepatitis C. These new antivirals are considered to be much more effective in eradicating the virus than previously available therapy. In addition, the treatment is safer, of a shorter duration, and in many cases can be accomplished with oral therapy alone, without Interferon, which is known to have many side-effects. Effective with dates of service on or after October 1, 2016, the Department will begin providing prescription coverage for qualifying patients with a Metavir score of F3 down from F4 previously.
Hepatitis C drugs require prior authorization to be eligible for reimbursement by Medicaid. Additional information such as the criteria and the necessary prior authorization request forms can be found on the HFS Criteria and Forms webpage.
Questions regarding this notice should be directed to the Bureau of Professional and Ancillary Services at 1-877-782-5565.
Felicia F. Norwood
Director
