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EFFECTIVE 1/1/23: Medicaid Hepatitis C Treatment Coverage and PDL Update

Date: 11/01/22

Beginning January 1, 2023, Texas Medicaid will designate one medication as the primary preferred Direct-Acting Antiviral (DAA) drug option for treating Hepatitis C infection. Texas Health and Human Services (HHS) will designate all other DAA drugs on the Medicaid formulary as non-preferred.

The table below summarizes the national drug codes (NDCs) impacted by this change:*

Drug Name

NDC

January 1st, 2023 – PDL Status

Mavyret

  • 00074-2600-28
  • 00074-2625-28

Preferred

Epclusa

  • 61958-2201-01
  • 61958-2203-01
  • 61958-2204-01
  • 61958-2204-02
  • 61958-2205-01
  • 61958-2205-02

Non-Preferred

Vosevi

  • 61958-2401-01

Non-Preferred

All Superior Medicaid (STAR, STAR Health, STAR Kids, STAR+PLUS) members are eligible for DAA treatment with the primary preferred agent regardless of the member’s METAVIR fibrosis score, and prior authorization is not required. Additionally, any enrolled Medicaid provider can prescribe the preferred drug, and a drug screening is not required.

Please note the following updates, effective January 1, 2023:

  • HHS will publish an update to the Texas Medicaid Preferred Drug List (PDL) to designate preferred and non-preferred options for DAA treatment.
    • To find the preferred DAA Hepatitis C drug, please check the HHS VDP Preferred Drug List or use the HHS VDP formulary search tool.
    • Drugs identified on the PDL as preferred are available without prior authorization.
    • For any non-preferred DAA drugs, HHS will continue to apply PDL prior authorization criteria for all Medicaid clients, both fee-for-service and managed care.
  • HHS will retire the following clinical prior authorization request forms for Hepatitis C treatment agents:
    • Antiviral Agents for Hepatitis C Virus – Initial Request (HHS Form 1335)
    • Antiviral Agents for Hepatitis C Virus – Initial Request – Addendum (HHS Form 1342)
  • Superior will remove the Hepatitis C prior authorization forms found on Superior’s Forms webpage:
    • Hepatitis C Antiviral Agents Initial Authorization Request
    • Hepatitis C Antiviral Agents Standard Prior Authorization Addendum

If you have any questions, please contact Superior’s Pharmacy Department at 1-800-218-74533 ext. 22080.

*Please note, this article was updated on 12/19/2022 to include NDC's drug codes in the table above.