In the last six months:
- 4 more states (DE, FL, IL, PA) removed prior authorization requirements.
- 2 jurisdictions (SC, PR) removed prescriber restrictions.
- 2 states (SC, SD) removed substance use restrictions.
- South Dakota removed its fibrosis restrictions, making Arkansas the only state that still imposes this extreme barrier to care.
These shifts come at a pivotal time, as the White House proposes broadening access to treatment through a National Hepatitis C Elimination Program while CDC recently released new data showing alarmingly low rates of hepatitis C treatment — especially among Medicaid beneficiaries.
“Meaningful strides are made toward eliminating hepatitis C in the U.S. every time a state Medicaid program removes needless treatment access restrictions,” said Elizabeth Kaplan, Director of Health Care Access for CHLPI. “We applaud states that have removed prior authorization requirements and other barriers to care. However, more states must follow suit if we are to meet our goal of ridding the U.S. of hepatitis C altogether.”
There are still additional hurdles to overcome — most importantly outdated genotype testing requirements and lagging parity between states’ fee-for-service policies and implementation by their managed care organizations — but overall, the soil is ripe for a coordinated national effort towards eliminating hepatitis C as a public health threat. We urge Congress to seize this momentum and advance the White House proposal for a robust nationwide hepatitis C elimination program.
Overall Grades
A+ (11): Colorado, Delaware, Idaho, Michigan, Missouri, Oklahoma, Pennsylvania, Rhode Island, Virginia, Washington, Wisconsin
A (13): Alaska, California, DC, Hawaii, Illinois, Indiana, Louisiana, Massachusetts, New Hampshire, New York, Oregon, South Dakota, Texas
B (15): Alabama, Arizona, Connecticut, Florida, Kansas, Kentucky, Minnesota, Mississippi, New Mexico, North Carolina, Puerto Rico, South Carolina, Tennessee, Utah, Vermont
C (9): Georgia, Maine, Maryland, Montana, Nevada, New Jersey, Ohio, West Virginia, Wyoming
D (3): Iowa, Nebraska, North Dakota
F (2): Arkansas
Citation: Center for Health Law and Policy Innovation & National Viral Hepatitis Roundtable, Hepatitis C: State of Medicaid Access (2023), www.stateofhepc.org
Prior Authorization Requirements
No Prior Authorization for Most Patients (25): Alaska, Arizona, California, Colorado, DC, Delaware, Florida, Hawaii, Idaho, Illinois, Indiana, Louisiana, Massachusetts, Michigan, Missouri, New Hampshire, New York, Oklahoma, Oregon, Pennsylvania, Rhode Island, Texas, Virginia, Washington, Wisconsin
Prior Authorization Required (27): Alabama, Arkansas, Connecticut, Georgia, Iowa, Kansas, Kentucky, Maine, Maryland, Minnesota, Mississippi, Montana, Nebraska, Nevada, New Jersey, New Mexico, North Carolina, North Dakota, Ohio, Puerto Rico, South Carolina, South Dakota, Tennessee, Utah, Vermont, West Virginia, Wyoming
Citation: Center for Health Law and Policy Innovation & National Viral Hepatitis Roundtable, Hepatitis C: State of Medicaid Access (2023), www.stateofhepc.org
Fibrosis Restrictions
No Fibrosis Restrictions (51): Alabama, Alaska, Arizona, California, Colorado, Connecticut, DC, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Puerto Rico, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming
Fibrosis Restrictions (1): Arkansas
Citation: Center for Health Law and Policy Innovation & National Viral Hepatitis Roundtable, Hepatitis C: State of Medicaid Access (2023), www.stateofhepc.org
Sobriety Restrictions
No Substance Use Restriction (42): Alabama, Arizona, California, Colorado, Connecticut, DC, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Puerto Rico, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, Wyoming
Provider Must Address and/or Counsel Patient About Substance Use Issues Prior to Treatment (7): Alaska, Iowa, Minnesota, Mississippi, Montana, West Virginia, Wisconsin
Substance Use Restriction Prior to or During Treatment, Including Abstinence and Mandatory SUD Treatment (3): Arkansas, Nebraska, North Dakota
Citation: Center for Health Law and Policy Innovation & National Viral Hepatitis Roundtable, Hepatitis C: State of Medicaid Access (2023), www.stateofhepc.org
Prescriber Restrictions
No Prescriber Restrictions (48): Alabama, Alaska, Arizona, California, Colorado, Connecticut, DC, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana, Louisiana, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Puerto Rico, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming
Prescriber Restrictions (4): Arkansas, Illinois, Iowa, Nevada
Citation: Center for Health Law and Policy Innovation & National Viral Hepatitis Roundtable, Hepatitis C: State of Medicaid Access (2023), www.stateofhepc.org
Retreatment Restrictions
No Retreatment Restrictions (35): Alaska, Colorado Connecticut, DC, Delaware, Hawaii, Idaho, Illinois, Kansas, Louisiana, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, North Carolina, Oklahoma, Oregon, Pennsylvania, Puerto Rico, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Washington, Wisconsin
Retreatment Restrictions based on adherence, substance use, or SVR12 documentation (17): Alabama, Arizona, Arkansas, California, Florida, Georgia, Indiana, Iowa, Kentucky, Maryland, Maine, Montana, , New York, North Dakota, Ohio, West Virginia, Wyoming
Citation: Center for Health Law and Policy Innovation & National Viral Hepatitis Roundtable, Hepatitis C: State of Medicaid Access (2023), www.stateofhepc.org
Managed Care Restrictions
No Additional Restrictions in Managed Care (28): Arkansas, California, Colorado, Florida, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Minnesota, Mississippi, Missouri, New Mexico, New York, North Carolina, North Dakota, Ohio, Pennsylvania, Puerto Rico, Rhode Island, South Carolina, Tennessee, Virginia, Washington, West Virginia, Wisconsin
Additional Restrictions and/or Lack of Transparency in Managed Care (14): Arizona, DC, Delaware, Georgia, Hawaii, Maryland, Massachusetts, Nebraska, Nevada, New Hampshire, New Jersey, Oregon, Texas, Utah
N/A, State Doesn’t Contract with Managed Care (10): Alabama, Alaska, Connecticut, Idaho, Maine, Montana, Oklahoma, South Dakota, Vermont, Wyoming
Citation: Center for Health Law and Policy Innovation & National Viral Hepatitis Roundtable, Hepatitis C: State of Medicaid Access (2023), www.stateofhepc.org
Compare this snapshot
with our previous updates: