Hawaii

State of Hepatitis C
Medicaid Access:

B

Hawaii

Liver damage restrictions

Hawaii Medicaid FFS does not impose liver damage restrictions. Most Managed Care Organizations (MCOs), including Hawaii Medical Service Association, Ohana Health Plan, and UnitedHealthcare Community Plan, also do not impose liver damage restrictions. AlohaCare and Kaiser Permanente do not have publicly available hepatitis c coverage criteria.

Sobriety restrictions

Hawaii Medicaid FFS requires that providers evaluate alcohol use and urine toxicology results prior to treatment for adherence considerations. Hawaii Medical Service Association, and UnitedHealthcare Community plan impose similar screening requirements. Ohana Health Plan requires patients to be abstinent from alcohol or substance use and requires a negative toxicology screen within the past 100 days prior to initiation of treatment. AlohaCare and Kaiser Permanente do not have publicly available hepatitis c coverage criteria.

Prescriber restrictions

Hawaii Medicaid FFS requires that a prescription be written by or in consultation with a specialist. Hawaii Medical Service Association and Ohana Health Plan also require a specialist to prescribe or consult. UnitedHealthcare Community Plan appears to require a specialist prescription. AlohaCare and Kaiser Permanente do not have publicly available hepatitis c coverage criteria.

Recommendations

  • Remove sobriety and prescriber requirements.
  • Ensure parity across the Medicaid program and ensure transparency so coverage criteria for FFS and MCO plans are publicly accessible.

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