Between August 2023 and February 2024:
- 3 more states (CT, KS, NC) removed prior authorization requirements.
- 3 states (NE, ND, WY) removed substance use restrictions.
- 2 states (NY, OH) removed retreatment restrictions.
- Arkansas removed its fibrosis restriction, which means there are no longer any states imposing this extreme barrier to care.
Now, 28 jurisdictions have removed PA requirements for most patients. For the first time ever, there are more states that don’t require prior authorization than ones that do.
These updates mark an inflection point in the decade-long push to broaden access to HCV cures: the Department of Justice (DOJ) recently affirmed the right of people who use drugs to access treatment for HCV under the Americans with Disabilities Act, while a White House proposal for a groundbreaking National HCV Elimination Initiative awaits Congressional action.
“We’re thrilled that the majority of state Medicaid programs now recognize that prior authorizations have led to missed opportunities to cure hepatitis C” said Adrienne Simmons, Director of Programs for NVHR. “We urge states to backtrack and reach out to residents who got lost in the prior authorization shuffle over the last decade and still need to get cured.”
Overall, the removal of restrictive, outdated policies has laid the groundwork for a coordinated national effort towards eliminating hepatitis C as a public health threat. CHLPI and NVHR urge Congress to seize upon this momentum and advance the White House proposal for a robust nationwide hepatitis C elimination program.
Overall Grades
A+ (18): Colorado, Delaware, District of Columbia, Idaho, Kansas, Michigan, Missouri, New Hampshire, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, Rhode Island, Texas, Virginia, Washington, Wisconsin
A (10): Alaska, Arizona, California, Connecticut, Hawaii, Illinois, Indiana, Louisiana, Massachusetts, South Dakota
B (12): Alabama, Florida, Kentucky, Minnesota, Mississippi, New Mexico, Ohio, Puerto Rico, South Carolina, Tennessee, Vermont, Wyoming
C (10): Georgia, Maine, Maryland, Montana, Nebraska, Nevada, New Jersey, North Dakota, Utah, West Virginia
D (2): Arkansas, Iowa
Citation: Center for Health Law and Policy Innovation & National Viral Hepatitis Roundtable, Hepatitis C: State of Medicaid Access (2024), www.stateofhepc.org
Prior Authorization Requirements
No Prior Authorization for Most Patients (28): Alaska, Arizona, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Kansas, Louisiana, Massachusetts, Michigan, Missouri, New Hampshire, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, Rhode Island, Texas, Virginia, Washington, Wisconsin
Prior Authorization Required (24): Alabama, Arkansas, Georgia, Iowa, Kentucky, Maine, Maryland, Minnesota, Mississippi, Montana, Nebraska, Nevada, New Jersey, New Mexico, 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 (2024), www.stateofhepc.org
Fibrosis Restrictions
No Fibrosis Restrictions (52): Alabama, Alaska, Arizona, Arkansas, 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
Citation: Center for Health Law and Policy Innovation & National Viral Hepatitis Roundtable, Hepatitis C: State of Medicaid Access (2024), www.stateofhepc.org
Sobriety Restrictions
No Substance Use Restriction (43): Alabama, Arizona, California, Colorado, Connecticut, District of Columbia, 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, Wisconsin, Wyoming
Provider Must Address and/or Counsel Patient About Substance Use Issues Prior to Treatment (8): Alaska, Iowa, Minnesota, Mississippi, Montana, Nebraska, North Dakota, West Virginia
Substance Use Restriction Prior to or During Treatment, Including Abstinence and Mandatory SUD Treatment (1): Arkansas
Citation: Center for Health Law and Policy Innovation & National Viral Hepatitis Roundtable, Hepatitis C: State of Medicaid Access (2024), www.stateofhepc.org
Prescriber Restrictions
No Prescriber Restrictions for Simplified Treatment (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 (2024), www.stateofhepc.org
Retreatment Restrictions
No Retreatment Restrictions (37): Alaska, Colorado, Connecticut, District of Columbia, Delaware, Hawaii, Idaho, Illinois, Kansas, Louisiana, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, 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, Wisconsin
Retreatment Restrictions based on adherence, substance use, or SVR12 documentation (15): Alabama, Arizona, Arkansas, California, Florida, Georgia, Indiana, Iowa, Kentucky, Maine, Maryland, Montana, North Dakota, West Virginia, Wyoming
Citation: Center for Health Law and Policy Innovation & National Viral Hepatitis Roundtable, Hepatitis C: State of Medicaid Access (2024), www.stateofhepc.org
Managed Care Restrictions
No Additional Restrictions in Managed Care (33): Arkansas, Arizona, California, Colorado, Delaware, District of Columbia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, New Hampshire, New Mexico, New York, North Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Puerto Rico, Rhode Island, Tennessee, Texas, Virginia, Washington, West Virginia, Wisconsin
Additional Restrictions and/or Lack of Transparency in Managed Care (9): Florida, Georgia, Hawaii, Maryland, Nebraska, Nevada, New Jersey, South Carolina, 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 (2024), www.stateofhepc.org
Compare this snapshot
with our previous updates: