By Cory Bradley, PharmD
As in past years, OHA will continue to set the Hepatitis C Prior Authorization criteria for all Oregon Medicaid members, including those enrolled in CCOs. CCOs are still responsible for reviewing and effectuating approvals, but by applying State criteria. After substantial changes to criteria were made early in 2019, there has been little clinical criteria in place and therefore not much to announce that impacts member’s eligibility for treatment. In short, essentially all members should qualify for hepatitis C treatment. A few notable changes to the criteria, as made by OHA, include:
- Zepatier no longer considered preferred (but largely unused in recent time).
- Mavyret maximum duration in treatment naïve reduced to 8 weeks in cirrhosis. This follows a recent FDA indication change that showed 12 weeks did not improve SVR rates vs 8 weeks.
- Specific restrictions on HCV RNA testing documentation removed. It should be emphasized that an accurate diagnosis of chronic hepatitis C infection typically includes a positive detection of a viral load. Diagnosis should not rely solely on HCV antibody testing. This was only removed to address a common barrier for OLD testing not qualifying.