Georgia

State of Hepatitis C
Medicaid Access:

C

Georgia

Liver damage restrictions

Fee-For-Service (FFS) does not have any liver damage requirements. One Managed Care Organization (MCO), Amerigroup Community Care, also does not have any liver damage requirements. One MCO (WellCare of Georgia) appears to require severe liver damage (F3 or greater). Two MCOs (Peach State Health Plan and CareSource) do not have publicly available information.

Sobriety restrictions

FFS requires a patient to enroll in a substance use program if the individual is currently using alcohol or intravenous drugs. One MCO (Amerigroup Community Care) has the same requirement. One MCO (WellCare of Georgia) considers patients with active substance or alcohol use on a case-by-case basis and in coordination with a substance treatment specialist. Two MCOs (Peach State Health Plan and CareSource) do not have publicly available information.

Prescriber restrictions

FFS does not have any prescriber restrictions. One MCO (Amerigroup Community Care) also does not have any prescriber restrictions. One MCO (WellCare of Georgia) appears to require a prescription be written by or in consultation with a specialist. Two MCOs (Peach State Health Plan and CareSource) do not have publicly available information.

Recommendations

  • Eliminate liver damage, sobriety and prescriber restrictions.
  • Ensure parity across FFS and MCOs and transparency regarding hepatitis C coverage criteria.

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