05/11/2023 Background:
HHSC published the notice “Preferred Mavyret for Hepatitis C Infection Treatment and Change to Quantity Limit for Hepatitis C Medications” on May 1, 2023.
Key Details:
This update is to clarify the following notice regarding the quantity limit change for Hepatitis C infection treatment. The quantity limit change in this notice applies to all Hepatitis C DAA medications, not just the NDCs listed in the table below.
Quantity Limit Change
HHSC intends this initiative to increase awareness, screening, diagnosis, and treatment for Medicaid clients. HHSC will help improve access and adherence by allowing prescribers to write prescriptions for the entire course of therapy so clients will no longer need to request additional refills throughout their treatment duration. Prescribers may choose to write a prescription for the entire treatment cycle or have the client return for further testing if warranted. This change applies to all Hepatitis C DAA medications.
By May 25, 2023, MCOs must update pharmacy quantity supply limits and maximum day supply coverage on DAA medications to allow access to the entire course of therapy. Prescribers may identify some clients needing to take the medication longer than others. MCOs may allow longer treatment duration upon prescriber request. MCOs must inform their providers and members of this change.
Reminder
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 HHSC does not require a drug screening. The table below summarizes the national drug codes (NDCs) impacted by the PDL change:
| Drug Name |
NDC |
Jan 1, 2023 PDL status |
| Mavyret |
00074260028
00074262528 |
Preferred |
| Epclusa |
61958220101
61958220301
61958220401
61958220402
61958220501
61958220502 |
Non-Preferred |
| Vosevi |
61958240101 |
Non-Preferred |
HHSC published an update to the Texas Medicaid Preferred Drug List (PDL) on Jan. 1, 2023, designating the preferred and non-preferred options for DAA treatment. HHSC also included the changes in the daily PDL file delivered to managed care plans via TXMedConnect. PDL statuses were future-dated to reflect the Jan. 1 changes.
HHSC did not change the PDL status for all other non-preferred DAA drugs currently on the formulary. For any non-preferred DAA drugs, HHSC will continue to apply PDL prior authorization criteria for all Medicaid clients, both fee-for-service and managed care.
HHSC asks MCOs to continue to remind their providers and members regarding the availability of Hepatitis C treatment coverage.
Contact: vdp-operations@hhsc.state.tx.us