Pennsylvania

State of Hepatitis C
Medicaid Access:

A-

Pennsylvania

Liver damage restrictions

Pennsylvania FFS and most MCOs do not impose liver damage restrictions. UnitedHealthcare does not make its prior authorization requirements publicly available.

Sobriety restrictions

Pennsylvania FFS and most MCOs do not impose sobriety restrictions. UnitedHealthcare does not make its prior authorization requirements publicly available.

Prescriber restrictions

Pennsylvania FFS does not impose prescriber restrictions. While six MCOs apply the same criteria as FFS, UPMC For You still requires a specialist to prescribe, and UnitedHealthcare does not make its prior authorization requirements publicly available.

Recommendations

  • Ensure transparency regarding hepatitis C coverage requirements and parity across FFS and MCO programs.
  • Remove prior authorization for patients who qualify for simplified treatment.

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