New Jersey

Liver damage restrictions

Fee-For-Service (FFS) and managed care organizations (MCOs) do not impose liver damage requirements.

Sobriety restrictions

FFS and four MCOs, Aetna Better Health of New Jersey, Amerigroup, Horizon NJ Health, and UHC do not impose sobriety restrictions. One MCO, WellCare, requires that providers evaluate urine toxicology results and consider treatment for active substance users on a case-by-case basis.

Prescriber restrictions

FFS and two MCOs, Aetna and Amerigroup, do not impose prescriber restrictions. One MCO, UnitedHealthcare Community Plan, requires a specialist to prescribe. Two MCOs, Horizon NJ Health and WellCare, have unclear prescribing requirements.

Recommendations

• Ensure hepatitis C coverage parity across FFS and MCO programs and provide transparency regarding hepatitis C coverage criteria.
• Consider removing prior authorizations for treatment naïve patients.