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, AlohaCare, and UnitedHealthcare Community Plan, do not impose liver damage restrictions. Kaiser Permanente does not have publicly available hepatitis C coverage criteria.

Sobriety restrictions

Hawaii Medicaid FFS, Hawaii Medical Service Association, Ohana Health Plan, and UnitedHealthcare Community Plan require that providers evaluate alcohol use and urine toxicology results prior to treatment for adherence considerations. AlohaCare does not appear to impose any sobriety restrictions. Kaiser Permanente does 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 AlohaCare also require a specialist to prescribe or consult. Ohana Health Plan and UnitedHealthcare Community Plan require a specialist or a primary care physician with expertise in hepatitis C to prescribe. Kaiser Permanente does not have publicly available hepatitis C coverage criteria.

Recommendations

  • Remove sobriety and prescriber requirements.
  • Ensure parity between FFS and MCO plans and transparency of coverage criteria among MCO plans.

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