Illinois

Liver damage restrictions

Fee-For-Service (FFS) does not impose liver damage requirements. Three managed care organizations (MCOs), Blue Cross Community Health Plan, Aetna Better Health, and Molina, also do not impose liver damage requirements. Three MCOs, Meridian Health Plan, CountyCare Health Plan, and YouthCare, do not provide hepatitis C coverage information publicly.

Sobriety restrictions

FFS requires screening for active substance use. Two MCOs, Blue Cross Community Health Plan and Molina, require that the provider attest that they will address any patient alcohol or drug misuse. Aetna Better Health requires three months’ abstinence from alcohol and substance use. Three MCOs, Meridian Health Plan, CountyCare Health Plan, and Youthcare, do not provide hepatitis C coverage information publicly.

Prescriber restrictions

FFS requires a prescription to be written by or in consultation with a specialist. Two MCOs, Blue Cross Community Health Plan and Aetna Better Health, also require a specialist to prescribe or consult. One MCO, Molina, does not appear to impose prescriber requirements. Three MCOs, Meridian Health Plan, CountyCare Health Plan, and YouthCare, do not provide hepatitis C coverage information publicly.

Recommendations

• Eliminate sobriety and prescriber restrictions.
• Ensure parity across FFS and MCOs and transparency regarding hepatitis C coverage requirements for MCOs.