Maryland

Liver damage restrictions

Fee-For-Service (FFS) and most managed care organizations (MCOs), Aetna, Amerigroup, CareFirst, Kaiser Permanente, Jai, Maryland Physicians Care, MedStar, and UnitedHealthcare Community Plan, do not impose any liver damage restrictions. One MCO, Priority Partners, has unclear liver damage restrictions.

Sobriety restrictions

FFS and most MCOs (Aetna, Amerigroup, CareFirst, Kaiser Permanente, Jai, Maryland Physicians Care, MedStar, and UnitedHealthcare Community Plan) do not impose sobriety restrictions. Priority Partners requires screening for active alcohol and substance use.

Prescriber restrictions

FFS and most MCOs (Aetna, Amerigroup, CareFirst, Jai, Maryland Physicians Care, MedStar, and UnitedHealthcare Community Plan) require that patients have a treatment plan developed by or in collaboration with a provider with expertise in hepatitis C management but does not require certain specialists to prescribe or consult. Kaiser Permanente requires a prescription by or in consultation with a gastroenterologist, hepatologist, infectious disease or transplant specialist. Priority Partners has unclear prescriber restrictions.

Recommendations

• Ensure parity across FFS and MCO programs and transparency about coverage criteria.
• Remove prior authorization for simplified treatment.