Illinois

Liver damage restrictions

Fee-For-Service (FFS) does not impose liver damage requirements. Two Managed Care Organizations (MCOs), BlueCross Community Health Plan and Illinicare, also do not impose liver damage requirements. One MCO, Molina, requires severe liver damage (F3 or greater). Three MCOs, Meridian Health Plan, CountyCare Health Plan, and NextLevelHealth, do not provide hepatitis C coverage information publicly.

Sobriety restrictions

FFS requires screening for active substance use. One MCO, BlueCross Community Health Plan, also requires screening. Two MCOs, Illinicare and Molina require six months of sobriety. Three MCOs, Meridian Health Plan, CountyCare Health Plan, and NextLevelHealth, do not provide hepatitis C coverage information publicly.

Prescriber restrictions

FFS requires a prescription to be written by or in consultation with a specialist. One MCOs, BlueCross Community Health Plan also requires a specialist to prescribe or consult. One MCO, Illinicare, requires a specialist to prescribe. One MCO, Molina, does not appear to impose prescriber requirements. Three MCOs, Meridian Health Plan, CountyCare Health Plan, and NextLevelHealth, 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.